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Politics : View from the Center and Left -- Ignore unavailable to you. Want to Upgrade?

To: JohnM who wrote (179185)	1/13/2012 2:31:46 AM
From: bentway	Respond to of 541936

Well, I only hear about Medicare fraud, not private insurance fraud, though I'm sure it exists. medicare.gov en.wikipedia.org Types of Medicare fraud Medicare fraud is typically seen in the following ways: [3][ specify] Phantom Billing: The medical provider bills Medicare for unnecessary procedures, or procedures that are never performed; for unnecessary medical tests or tests never performed; for unnecessary equipment; or equipment that is billed as new but is, in fact, used. In which case, every form of billing, phantom or patient, can be prevented through carefully checking.Patient Billing: A patient who is in on the scam provides his or her Medicare number in exchange for kickbacks. The provider bills Medicare for any reason and the patient is told to admit that he or she indeed received the medical treatment.Upcoding scheme and unbundling: Inflating bills by using a billing code that indicates the patient needs expensive procedures.A 2011 crackdown on fraud charged "111 defendants in nine cities, including doctors, nurses, health care company owners and executives" of fraud schemes involving "various medical treatments and services such as home health care, physical and occupational therapy, nerve conduction tests and durable medical equipment." [4] In recent years, as regulatory requirements tightened [5] and law enforcement has stepped up, Medicare fraud has shifted away from sectors such as durable medical equipment [6] and HIV/AIDS infusion injections and into other areas such as ambulance fraud and hospice care fraud. [7] [8] Durable medical equipment or home medical equipment describes medically required equipment and services used in the home such as wheelchairs, hospital beds, nebulizers, and oxygen equipment, and represents less than two percent of total Medicare spending. [9] Even in other countries, particularly in South-East Asia, there are doctors who over-charge American patients, through Medicare (or Tricare), charging them US rates, much higher than actual medical cost in their respective countries. This is a type of insurance fraud, which, unfortunately, Medicare continually overlooks and fails to take into account.[ citation needed]