Examples of Fraud

Incorrect reporting of diagnoses or procedures to maximize payments;
Billing for services not furnished and/or supplies not provided. This includes billing Medicare for appointments that the patient failed to keep;
Billing that appears to be a deliberate application for duplicate payment for the same services or supplies, billing both Medicare and the beneficiary for the same service or billing both Medicare and another insurer in an attempt to get paid twice;
Altering claim forms, electronic claim records, medical documentation, etc. to obtain a higher payment amount;
Soliciting, offering, or receiving a kickback, bribe, or rebate, e.g., paying for a referral of patients in exchange for the ordering of diagnostic tests and other services or medical equipment;
Unbundling or "exploding" charges, e.g., the billing of multichannel set of lab tests to appear as if the individual tests had been performed;
Completing Certificates of Medical Necessity (CMNs) for patients not personally and professionally known by the provider;
Participating in schemes that involve collusion between a provider and a beneficiary, or between a supplier and a provider and result in higher costs or charges to the Medicare program;
Participating in schemes that involve collusion between a provider and a carrier employee where the claim is assigned, e.g., the provider deliberately overbills for services, and the carrier employee then generates adjustments with little or no awareness on the part of the beneficiary;
Billing based on "gang visits," e.g., a physician visits a nursing home and bills for 20 nursing home visits without furnishing any specific service to individual patients.;
Misrepresentations of dates and descriptions of services furnished or the identity of the beneficiary or the individual who furnished the services;
Billing non-covered or non-chargeable services as covered items.;
Repeatedly violating the participation agreement, assignment agreement, and the limitation amount;
Using another person's Medicare card to obtain medical care;
Giving false information about provider ownership in a clinical laboratory; and
Using the adjustment payment process to generate fraudulent payments.

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Medicare Part A
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