Medicare Fraud

A vast majority of Medicare payment errors are usually simple mistakes and are not the result of physicians, providers, or suppliers trying to take advantage of the Medicare system. If you do have a concern or question about a Medicare claim submitted on your behalf, you should discuss it directly with your physician, provider, or supplier that provided the service.

Most of the physicians, providers, and suppliers who serve people with Medicare coverage are committed to providing high quality care to their patients and to billing the program only for the payments they have earned. However, there are some individuals who are intent on defrauding Medicare. This involves cheating the Medicare program (and in some cases the people with Medicare who are liable for co-payments) out of millions of dollars annually. Medicare fraud does take a lot of money from the medicare program on a yearly basis. People that have Medicare end up paying for the fraud with higher premiums.

Medicare has been taking strong action to fight Medicare fraud and abuse. Their goal is to make sure that Medicare does business only with those physicians, providers, and suppliers who provide people with Medicare with high quality services.

The effort to prevent and detect Medicare fraud involves cooperation between The Centers for Medicare and Medicaid Services (CMS), the people with Medicare, the providers of Medicare services which includes the providers, physicians, and suppliers. Additonal State and Federal Agencies such as the Department of Health and Human Services Office of the Inspector General, the Federal Bureau of Investigation (FBI), and the Department of Justice also get involved.

Detecting and Preventing Medicare Fraud

You can help detect and prevent Medicare fraud if you know what to look for. Medicare fraud is purposely billing Medicare for services that were never provided or received. Medicare fraud may involve the billing of Medicare or another insurer for services or items that you never received. It may involve the billing of Medicare for services or equipment that are different from what you received. The use of a Medicare card from someone else in order to obtain medical supplies, equipment or care. The billing of Medicare for home medical equipment even after it has been returned.

It is easier to detect Medicare fraud if you know what signs to look for. You should probably be suspicious if the provider tells you that the "test is free", and that they only need your Medicare number for their records. This may be the case for clinical laboratory test because for a person with Medicare there is no co-payment. Be aware if they state that Medicare wants you to have the service or item or that they know how to get Medicare to pay for it. If they state that the more tests they provide the cheaper they are or if they say the equipment or service is free and that it won't cost you anything.

Additional ways to detect Medicare fraud is if your provider charge co-payments on clinical lab tests and on Medicaid covered preventive services such as flu shots, prostate (PSA) tests and PAP smears. If the provider typically waives co-payments on any services without checking your ability to pay. If the provider advertise "free consultations" for people with Medicare coverage or they provider that claims to represent Medicare. Providers that use scare tactics or pressure to sell you medical services or tests that are high in price. If the provider bills Medicare for services that you didn't receive or if they use telemarketing and door-to-door selling as marketing tools.

It is definitely in your best interest report suspected Medicare fraud. Health care fraud, whether against Medicare or private insurers, increases everyone's health care costs, much the same as shoplifting increases the costs of the food we eat and the clothes we wear. If we are to maintain and sustain our current health care system, we need to work together to reduce medical costs. Reporting Medicare fraud is an important part of keeping Medicare costs reasonable.