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Health Care Billing Errors and Fraud

Beware of health care providers who file false claims

What you can do

If you think that your provider is not billing accurately, you can take several steps:

  • Always review your Medicare Summary Notice (MSN) or health insurance Explanation of Benefits (EOB) for errors or mistakes. Use our MSN decoder to understand what’s in your summary notice.

  • Check past MSNs or EOBs to see whether there's a pattern of billing issues.

  • Contact the provider. It could be an error that your provider will correct, or he or she may explain why the coding is correct.

  • If you have Medicare and need help, you can contact your local Senior Medicare Patrol (SMP). Trained SMP volunteers take complaints about potential health care fraud, investigate them and then refer them to the proper agency or official. Find your local SMP.

  • If the provider cannot resolve your billing concerns, report it.

Where to report

  • If you have Medicare, you can report questionable billing practices to Medicare.
    Phone: 1-800-633-4117 (1-800-MEDICARE)
    TTY: 1-877-486-2049

  • Report questionable billing practices to your insurance company’s antifraud department. You should find a number to report fraud on your insurance Explanation of Benefits (EOB).

  • If you are on Medicaid, you should report your concerns to the State Medical Assistance Office.

  • Military personnel and veterans can report to Tricare.

  • You may also want to contact your state insurance department.

Also of interest: Protect yourself from medical identity theft.

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