medicare fraud

The menace of Health care fraud occurs in the United States when false reports of medical conditions are made to health care providers or even to the government; these false statements are given in order to claim an otherwise non-deserved benefit from the program. Sometimes, it involves producing fabricated reports concerning a patient’s condition, disease, addiction, crimes. This action is a not too distant kind of a white collar crime and it could also be perpetrated by a practitioner using any of the following means:

  • Obtaining prescription pills which are fully covered for and some, definitely not needed to sell at the black market
  • Making bills for care services that were never carried out or making dual claims for the same service
  • Presenting the bill for a non covered service as a covered service
  • Modification of patient’s medical records
  • Use of unlicensed staff as well as writing prescriptions for bogus or unnecessary treatments. 

This system of healthcare fraud has reached a troubling point because it is statistically reported that 10 cents out of every dollar that is spent on the healthcare sector is used to satisfy the greed of healthcare fraudsters. This crime does not go without it’s consequences as it could lead to an increase in health care premiums, and also increase taxes.

It is the duty of the Federal Bureau of Investigation to intercept the successful practice of this criminal act; they often carry out their task in partnership with different federal, state and local agencies, the National Health Care Anti-Fraud Association, the National Insurance Crime Bureau, and insurance investigative units. 

Health care abuse are practices that are associated with terribly unprofessional conducts that result in wastage and unnecessary expenses such as: misusing codes on a claim, making excessive charges for services and supplies, billing for unnecessary medical services.


To ensure that one does not fall a victim of Health care fraud, it is important to adhere to the following tips:

  • Ensure that your health insurance information is tightly secured, do not allow unauthorized and unnecessary access to the information; it is important that we use it mundfully when we are at the hospital or at the pharmacy.
  • When asked to provide your healthcare information in return for a free service, this service is most likely an attempt to make fraudulent charges to your insurance company, strongly refuse to fall into that trap. 
  • Endeavour to always cross-check your billings and also be sure to ensure that the dates, locations and services all tally with the services you received, and where any information does not match, quickly contact your healthcare insurance provider


While the sad story of health care fraud is such that’s recurring and affecting the majority of American citizens, it is important to know the role you can play to ensure that their activities are not always successful;

  • Ensure that you validate all member ID cards prior to rendering any services
  • When submitting your bills, it should be accurate, matching the services rendered and the bills charged 
  • Try to avoid unnecessary prescriptions and unnecessary medical services 
  • Report all suspicious activities to the appropriate authorities