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How to Avoid Medicare Claims Scams

Surjeet Thakur - Google Adwords Expert Chandigarh India

Surjeet Thakur

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What is Medicare Advantage? – Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by private companies approved by Medicare. … You’ll get your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage from theMedicare Advantage Plan and not Original Medicare.

Medicare Claims & Reimbursement

Although your doctor or other health care provider is generally responsible for filing a Medicare claim for each health care service, sometimes you will have to fill out a Medicare claim yourself to receive Medicare reimbursement – Its good thing

But today time there are lots of hospital, individual linked with Medicare Claims Scams – here we just add & share a information how to avoid and safe from scams.

Health care scams cost Americans billions of dollars each year. Taxpayer-funded programs such as Medicare, Medicaid and others are among the biggest victims. This makes health-care fraud one of America’s largest taxpayer ripoffs.

Organized crime rings hatch many schemes. Hospital chains, individual employees and even patients can be involved

The Medicare scams

Phantom treatments. Dishonest medical providers will bill health insurers for expensive treatments, tests or equipment you never received – and for illnesses or injuries you don’t even have.

Double billing. Unethical providers may double- or triple-bill health insurers for the same treatments, hoping the insurer won’t discover the overruns in the big stack of bills.

Shoddy care. You might receive shoddy or substandard treatment for real and urgent medical problems. One eye doctor shined pen lights into patients’ eyes and said he’d performed cataract surgery. Surgeons have used defective pacemakers and catheters during heart surgeries, which have killed patients or required more surgeries to correct the problems.

Unneeded care. You might receive dangerous and even life-threatening treatment you don’t need. One surgeon performed heart surgery on patients who didn’t need it.

Bogus insurers. Insurance agents or brokers sell you low-cost health coverage from fake insurance companies. Then they take your premiums and disappear. You’re left without vital health coverage, and don’t even know it until you make a claim.

Identity theft. Cheaters steal your medical ID number, then use it to bill health programs tens of thousands of dollars for phantom treatment. Crooks steal your health info from dumpsters behind medical clinics, break into doctor offices and steal files, and hack into computer databases containing your records.

Rolling labs. Mobile diagnostic labs give needless or fake tests or physical exams to consumers, then bill health insurers for expensive procedures.

Runners. A person hired by a medical provider to drum up business trolls through neighborhoods, often low-income areas, enticing people to come to a clinic for tests. These runners will even round up children for unneeded tests and procedures.


Any current or former employee of a hospital, nursing home, hospice, or other healthcare organization who has knowledge of overbilling, the payment or receipt of illegal kickbacks, or other schemes to defraud Medicare and Medicaid may be able to file a whistleblower lawsuit. In addition, independent contractors, consultants, and other individuals who have knowledge of healthcare fraud at hospitals may also be eligible to take legal action and receive a monetary reward for their efforts.

These types of qui tam cases may involve the following types of professionals:

  • Hospital, nursing home, and hospice administrators
  • Doctors, nurses, and physician assistants
  • Benefit administrators
  • Accountants
  • Benefit consultants
  • Medical billing specialists
  • Medical coding specialists
  • Coding supervisors

The price you pay

Coverage drained. Your coverage limits might be drained by worthless and unnecessary treatments.

Financial disaster. Inflated or phantom medical bills can increase your co-payment, beyond your ability to pay. This could force you into collections and damage your credit rating. And if you bought health insurance that ends up completely fake, you could face financial disaster if you must pay large medical bills with your life savings because your policy’s worthless.

False medical record. Your medical record contains false information about illnesses, diseases, injuries or other problems you never had. Your information is available to insurers, so you could be denied health coverage or pay higher premiums because of a trumped-up medical record.

Premiums rise. Your health premiums rise because insurers pass the cost of fraud onto policyholders. High health premiums discourage employers from offering this needed employee benefit.

Personal distress. You receive bogus or needless treatments that are painful, distressing, can threaten your health — and even kill you.

Taxpayer ripoff. Billions of your tax dollars pay for fraudulent claims against Medicare, Medicaid and other taxpayer-funded health programs every year. These are your tax dollars being stolen.

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