Medicare Fraud Hurts You
By: Source: AARP.org Date Posted: 2004-03-01 00:00:00-05:00
Fraud and abuse affect everyone-those with Medicare and Medicaid, as well as those with private insurance. They contribute to the rising cost of health care and may lessen the quality of your care.
The vast majority of physicians and other health care providers are honest and legitimate, but a few aren't. Those people steal billions of dollars from the health care system each year. Even more dollars are lost to errors in billing that are never found.
Reducing fraud and abuse are essential to maintain strong and affordable health care. This is especially true for Medicare. Fighting fraud strengthens the integrity of the Medicare Trust Fund.
With the recently passed Medicare prescription drug benefit due to go into effect in 2006, it's even more important to stop fraud whenever possible. This takes watchful eyes - especially for those who benefit from Medicare and Medicaid but also for those whose relatives or friends do..
In recent years, the federal government increased prevention and enforcement efforts. These efforts return millions of dollars to the Medicare program and at the same time stop millions from being lost.
America is fighting back, and you can play a key role in reducing fraud and abuse.
How you can help.
You are the first line of defense against Medicare fraud. Why? Because you are in the best position to spot fraud at the beginning, right in your own home. You can spot questionable charges when your Medicare Summary Notice comes in the mail.
Your first step is to check each Medicare statement you receive and answer these questions:
- Did you receive the service or product for which Medicare was billed?
- Did your doctor order the service or product for you?
- To the best of your knowledge, is the service or product appropriate for your diagnosis or treatment? (If you have a question about a procedure or test, ask your doctor to explain it.)
Your next step is to get a second opinion, if you spot something questionable. Check with a knowledgeable relative or friend to confirm you are reading the Summary Notice right. Then call your doctor or other health care provider. The charge could be a simple billing error. If so, your doctor or other health care provider will inform Medicare.
Take the third step if you can't resolve your questions. Report the questionable charges to your Medicare carrier using the phone number at the top of your Medicare statement. Or you may report a questionable charge directly to the Medicare Fraud Hotline at 1-800-447-8477.
Medicare will then investigate and determine if a fraud has been committed.
But you can do more.
Treat your Medicare card like a credit card. Never give out your Medicare number over the phone unless you initiated the call.
If your card is lost or stolen, report it immediately.
Don't accept free medical equipment or services in exchange for your Medicare number. Nothing is ever free. Unscrupulous providers could bill Medicare for services or equipment you may have never received.
Stay informed. Know which services or equipment you are supposed to receive so you can avoid having Medicare charged for something you don't need.
Be alert for those who claim to "know how to bill Medicare" to get an uncovered item or service paid for. Unless the person represents a trusted organization or is personally known to you, the odds are it's a scam. Report it immediately to the Medicare Fraud Hotline.
What To Watch For
Look on your Medicare summary notice for these common examples of fraud and abuse. If you find any, you should report them immediately to the Medicare Fraud Hotline.
- Charges for more than once for the same service (double billing).
- Charges for services never performed or medical equipment or supplies that your doctor never ordered.
- Charges for inappropriate or unnecessary services.
- Charges for higher cost or new equipment while providing lower cost or used equipment.
AARP Resources
Does the Medicare prescription drug plan mean lower drug prices for you?
Medical discount cards can cost more than they're worth.
What the Medicare drug benefit means for you.
Additional Resources
Medicare
Medicare.gov
The official Medicare Web site spotlights fraud and abuse.
Fraud Alerts and Bulletins
See the latest alerts and bulletins on countering fraud from the Department of Health and Human Services Office of Inspector General.
Books
Find these books online at Barnes & Noble.com:
Crime in the Home Health Care Field: WorkPlace Violence, Fraud, and Abuse
Brian K. Payne, Charles C Thomas Publisher, Limited, February 2003
Lots of suggestions on preventing fraud in the home health care area.
License to Steal: How Fraud Bleeds America's Health Care System, Vol. 2
Malcolm K. Sparrow, Westview Press, July 2000
Find out how fraud happens in the health care industry.
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