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Is it Medicare fraud for a company to bill commercial insurance companies a higher fee-for-service than they are billing Medicare for the same service?

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Wiki User
2015-07-16 18:11:12
2015-07-16 18:11:12

Insurance companies negotiate rates for services at the best advantage to them. Companies with larger groups get the best rates becaues they have more economic leverage. Medicare is the 900 pound gorilla in the insurance world. So the short answer is no, it is not fraudulent. The reason is each insurance company will pay at their own negotiated rate regardless of how much the provider charges.

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