Identifying the Distinction Between Medicare Abuse and Fraud and how to Report Them?

 Health centers are an integral part of a country’s working mechanisms. When a patient undergoes medical treatment, there is some information, including billing and medicinal costs, which he is unaware of at the initial stages. Instead, people often rely on medical institutions to assist them in the best manner possible. However, medical abuse and fraud are common activities in different parts of the world, including Hawaii. 

Medicare scams and abuse are often used interchangeably, but they are quite distinct from one another. While both often involve charging patients unnecessary expenses and medical bills, they are not the same. Hence, it becomes essential to distinguish them from one another so that patients can identify them and take action accordingly.

What is Medicare Abuse?

Medicare abuse refers to the deliberate malpractices and improper conduct by medical staff members, including doctors, that do not fall within the purview of the professional code of conduct mandated by the hospital. Some of the examples related to medicare abuse are:

• Charging patients for services not medically necessary
• Not maintaining patients’ medical records properly
• Not allowing users full access to the medical records
• Misconduct with the patient or lack of cooperation with them

What is Medicare Fraud?

Medicare fraud pertains to planned activities where a medical team member or a group distorts facts to obtain unauthorized payment or any other benefit. Some examples of medical fraud are as follows:

• Charging patients for services not provided
• Falsifying medical records
• Misrepresentation of eligibility criteria
• Not notifying patients of the coverage's included in the medical insurance

Who is Most Vulnerable to Medical Fraud and Abuse?   

While medical fraud and abuse can happen to anyone, elderly patients are most susceptible to them. In fact, the link between elder abuse and healthcare fraud is often noted. This might involve nurses giving medicines not prescribed by the doctor to the elderly patient. And if it worsens the patient’s condition, then the healthcare fraud would involve conning the patient for his money.

Therefore, it becomes necessary to identify and distinguish these two medical malpractices so that patients are not misguided and are treated rightfully.

How do SMP Services help?

One of the best ways to save oneself from medicare fraud and abuse is to take help from the Senior Medicare Patrols (SMP). SMPs are a group of volunteer organizations instituted by the United States Department of Health and Human Services. Their task is to educate the senior citizens in the U.S. to detect, report, and prevent abuses, frauds, scams, etc, that might occur in medical institutions.

The SMP program began in 1997, and by 2019, it had recovered around $129 million from Medicare funds. So far, SMP has trained over 30,000 volunteers and has received over 300,000 complaints from patients.

How to Report Medicare Abuse and Fraud?

For the residents of Hawaii, reporting medical abuse and fraud is quite easy. All you have to do is obtain the number of the Medicare Hawaii Office in Oahu and contact them. You can also check out the nearest SMP center and report the abuse or fraud. However, there are a few details you should keep before reporting. These are as follows:

• Name of the fraudulent institution and its medicare number
• Information about the culprit’s identity. It could be his name or any other information
• Form of the misconduct or scam and specific details regarding the same
• The excessive amount charged in the fraud and for what services
• Details regarding the patient’s insurance, if any

With these pieces of information, you can reach out to the medicare office in Hawaii and report any financial conning that occurred with you.

Therefore, understanding the difference between medicare fraud and abuse is extremely important, especially if the patient is a senior citizen. Their frail health and greater reliance on medical services make them susceptible to fraud and scams. But with the assistance of Senior Medicare Patrol, the risk of any medicare scam is eliminated.