What is considered "Medicare fraud"?

Medicare fraud involves dishonest actions intended to unlawfully acquire Medicare benefits or payments. This can encompass a wide range of unethical behaviors, such as submitting false claims for payment, billing for services that were never provided, or inflating costs associated with medical services. This type of fraud not only undermines the integrity of the Medicare system but also leads to increased costs for the program and affects the quality of care for beneficiaries.

Accidental billing errors made by healthcare providers, although problematic, are not classified as fraud since they typically do not involve intent to deceive. Similarly, providing more services than needed for proper care might constitute overutilization or abuse but not necessarily fraud unless there is an intent to mislead or unlawfully benefit. Lastly, billing only for services that were provided is standard practice and aligns with the ethical guidelines governing healthcare, further differentiating it from fraudulent activity.