Medicare Fraud Hurts You
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.
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 (MSN) 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
Understanding Medicare Part D
Get the basics on Medicare drug coverage.
Additional Resources
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.
