Helping to Stop Medicare Fraud

It is estimated that Medicare fraud costs the government $60 to $90 billion per year in false or questionable claims. The government paid $47 billion in false or questionable Medicare claims in 2009 according to a new federal report obtained by the Associated Press in November. You can help stop this fraud by reporting suspicious activities to the Inspector General of the U. S. Department of Health & Human Services by calling (800) 447-8477 or sending an e-mail to [email protected]. If the activity turns out to be a fraud you may be eligible for a reward of up to $1,000. For more information on stopping Medicare fraud go to www.stopmedicarefraud.gov.

To spot a fraud you should be suspicious of doctors, health care providers, or suppliers that tell you the following:

  • The equipment or service is free; it won’t cost you anything, and they only need your Medicare number for their records
  • Medicare wants you to have the item or service.
  • They know how to get Medicare to pay for the item or service.

You should also be suspicious of doctors or plans that do the following:

  • Don't charge copayments without checking on your ability to pay • Advertise “free” consultations to people with Medicare
  • Claim they represent Medicare or a branch of the Federal government
  • Use pressure or scare tactics to sell you high-priced medical services or diagnostic tests
  • Bill Medicare for services you didn't get
  • Use telephone calls and door-to-door selling as marketing tools.
  • Offer non-medical transportation or housekeeping as Medicare approved services.
  • Put the wrong diagnosis on the claim so that Medicare will pay.
  • Bill home health services for patients who aren't confined to their home, or for Medicare patients who still drive a car.
  • Bill Medicare for medical equipment for people in nursing homes.
  • Ask you to contact your doctor and ask for a service or supplies that you don't need.
  • Bill Medicare for a power wheelchair or scooter when you don't meet Medicare's qualifications.
  • Offer you a kickback or some other type of bribe to bring your medical needs to a specific clinic or provider. This is illegal.
  • Offer you a discount on your deductible or regularly waive payments that you do not have a financial need for.
  • Tell you that the more tests you take, the cheaper they become in the future.
  • Bill Medicare for tests you receive as a hospital inpatient or within 72 hours of admission or discharge.

And watch out for these common fraud schemes:

  • People who approach you in parking lots, shopping centers, or other public areas and offer free services, groceries, transportation, or other items in exchange for your Medicare number. Just walk away.
  • People who call you claiming to be conducting a health survey and ask for your Medicare number. Just hang up.
  • Telephone marketers who pretend to be from Medicare or Social Security and ask for payment over the phone or Internet. Just hang up.
  • Nursing facilities that bill social activities as psychotherapy, provide therapies to patients who cannot benefit from them, and provide all patients with the same medical equipment.

You should also do the following:

  • Check your medical bills and explanations of insurance benefits for any health services or products that you didn't receive. And make sure you weren't billed twice for the same thing.
  • Check your credit reports for any unpaid bills for health services or products that you didn't receive.
  • Challenge any collection notices for health services or products you didn't receive.
  • Contact your health care provider about any unusual or questionable charges. They may just be mistakes. Report them to Medicare at (800) 633-4227 if your complaint is not resolved to your satisfaction.
  • Read your Medicare benefits statement carefully. If there is any health service or product listed that you did not receive or have prescribed for you, call the Inspector General of the U. S. Department of Health & Human Services at (800) 447-8477. Unscrupulous clinics, physician, and durable medical equipment providers may be billing you for goods or services you never received. This affects you ability to obtain those items when you really need them.
  • Never allow people to fill in information on a form after you've signed it. They may be adding things you did not receive or falsify other information in order to receive more money than they are due.
  • Guard your Medicare number as you would your SSN. Scammers will try to steal your number so they can file claims under your name.
  • Be aware that anyone who works in a clinic can commit Medicare fraud.
  • Be suspicious of anyone who solicits you at a clinic or medical facility that you receive services from. They may be trying to get your personal information in order to file fraudulent claims in your name.

And never let anyone borrow or pay to use your Medicare card. It's illegal and not worth it.