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What is Medicare Fraud & Abuse?

Medicare fraud happens when Medicare is billed for services or supplies you never got.
Abuse occurs  when Medicare is billed for services or supplies that aren’t medically necessary.

 

 

What is Medicare Fraud?

Most doctors, health care providers, suppliers, and private companies who work with Medicare are honest. However, there are a few who are not. The Medicare Program is prioritizing efforts to find and prevent fraud and abuse by working closely with health care providers and strengthening oversight.

Fraud costs the Medicare Program millions of dollars every year, and you end up paying for fraud with higher health care costs. Fraud schemes may be carried out by individuals, companies, or groups of individuals.

 

The following are examples of possible Medicare fraud:

A health care provider bills Medicare for services you never received.A supplier bills Medicare for equipment you never got.Someone uses another person’s Medicare card to get medical care, supplies, or equipment.Someone bills Medicare for home medical equipment after it has been returned.A company offers a Medicare drug plan that has not been approved by Medicare.A company uses false information to mislead you into joining a Medicare plan.

How to Spot & Report Fraud

Spotting Fraud

When you get health care services, record the dates on a calendar and save the receipts and statements you get from providers to check for mistakes. Compare this information with the claims Medicare processed to make sure you or Medicare weren’t billed for services or items you didn’t get.

3 Ways to Review Your Original Medicare Claims

Look at your Medicare Summary Notice (MSN).Visit www.MyMedicare.gov.Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

Reporting Fraud

If you think a charge is incorrect and you know the provider, you may want to call their office to ask about it. The person you speak to may help you better understand the services or supplies you got. Or, your provider may realize a billing error was made.

If you’ve contacted the provider and you suspect that Medicare is being charged for a service or supply you didn’t get, or you don’t know the provider on the claim, call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048

3 Tips for Fighting Fraud

You can help stop dishonest people by identifying and reporting cases of potential fraud.

3 easy things you can do to fight fraud:

Review your Medicare claims to make sure they are accurate.  Check them early — the sooner you see and report errors, the sooner we can stop fraud. Learn how to protect your personal information. Be on the lookout for suspicious activity.

http://www.medicare.gov/navigation/help-and-support/fraud-and-abuse/fraud-and-abuse-overview.aspx

 
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