What is "Medicare fraud"?

Medicare fraud refers to any misrepresentation or deception related to Medicare services or billing issues, which encompasses a wide range of unethical activities that violate Medicare regulations. This can include situations where false information is provided on claims, such as exaggerating services rendered, billing for services not provided, or using someone else's Medicare number to file claims. It is important to understand that fraud can be committed by various parties, including healthcare providers, suppliers, and beneficiaries, and is characterized by intentional deceit aimed at financial gain.

This definition is distinct from other concepts associated with billing and claims, such as errors or acceptable practices. For example, unintentional errors in billing for Medicare services are typically categorized as billing mistakes rather than fraud, highlighting the key distinction of intent. Similarly, the assertion that only providers make fraudulent claims does not capture the broader spectrum of individuals or entities that may engage in fraudulent activities related to Medicare. Understanding the nuances of Medicare fraud is crucial for recognizing and preventing such activities within the healthcare system.