Unusual Medicare Billing Patterns Are A Red Flag For Fraud

May 27, 2014


Unusual Medicare billing patterns can tip off fraud investigators.
Credit Patrisyu / freedigitalphotos.net

A ProPublica investigation earlier this month looked at how Medicare providers charged for their services in 2012 and found unusual billing patterns among a number of Florida care providers.

On average, most providers only charged for the most complex, expensive level of care during office visits about 4 percent of the time. But in Florida, nearly 100 Medicare providers with relatively high volume billed at the most expensive rate 100 percent of the time.

According to a U.S. attorney, unusual billing patterns are a red flag for fraud. And data analysis has become an important tool for Medicare fraud investigators in Florida.

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