Detection and Prevention Tips
What is Fraud?
Medicare fraud is purposely billing Medicare for services that were never provided or received.
Some examples of Medicare fraud include:
- Billing Medicare or another insurer for services or items you never got.
- Billing Medicare for services or equipment that is different from what you got.
- Use of another person’s Medicare card to get medical care, supplies, or equipment.
To help prevent Medicare fraud, whenever you receive a payment notice from Medicare, a Medicare Summary Notice (MSN), review it for errors. The payment notice shows what Medicare was billed for, what Medicare paid and what you owe. Make sure Medicare was not billed for health care services or medical supplies and equipment you did not receive. You can also view your MSN online at www.mymedicare.gov.
The following is a list of tips to prevent fraud:
- Don't ever give out your Medicare Health Insurance Claim Number (on your Medicare card) except to your physician or other Medicare provider.
- Do be cautious when you are offered free testing or screening in exchange for your Medicare card number.
- Do be cautious of any provider who maintains they have been endorsed by the Federal government or by Medicare.
- Do avoid a provider of health care items or services who tells you that the item or service is not usually covered, but they know how to bill Medicare to get it paid.
How to Report
It is in your best interest and that of all citizens to report suspected fraud. Health care fraud, whether against Medicare or private insurers, increases everyone's health care costs.
If you don’t remember a procedure that is listed, you should first call your physician, provider, or supplier listed on the Medicare Summary Notice. Many times a simple mistake has been made and can be corrected by your physician, provider, or supplier’s office when you call.
If your physician, provider, or supplier’s office does not help you with the questions or concerns or if you can’t contact them, you can do any of the following and explain the issue.
Write a letter to Medicare. Mail it to: Beneficiary Contact Center, PO Box 39, Lawrence KS, 66044.
Call the HHS (Health and Human Services) Office of Inspector General Hotline at 1-800-HHS-TIPS
Source: Centers for Medicare and Medicaid Services, “Protecting Medicare and You from Fraud”, www.medicare.gov.