- Call Medicare.gov at (800) 633-4227
- Call the Office of the Inspector General at (800) HHS-TIPS (800-447-8477)
- File an online report with the Office of the Inspector General
Do you get a reward for reporting Medicare fraud?
Under the False Claims Act (FCA), the government may pay a reward of up to 30% to people who report healthcare fraud. Congress has enacted laws that forbid retaliation against whistleblowers. Similar laws exist in many states. If you've witnessed Medicare fraud in your workplace, these laws may protect you while you do the right thing.
How do I report fraud, waste or abuse of Medicare?
You can report suspected fraud or corruption by:
- completing our reporting suspect fraud form
- completing our health provider fraud tip-off form
- calling our fraud hotline – 1800 829 403
- writing to us
How do I identify Medicare fraud?
- Call Medicare’s help line at 800-633-4227.
- Call the Office of Inspector General directly at 800‑HHS‑TIPS (800‑447‑8477, or TTY 800‑377‑4950).
- File an online report with the Office of Inspector General.
What do you need to know about Medicare fraud?
“Medicare fraud” is actually a blanket term encompassing different fraudulent activities related to the Medicare system. What is perhaps most staggering is the amount of money alleged to be falsely billed by this collection of once-trusted medical professionals and agencies. The total? Somewhere around $1.3 billion.
How to detect Medicare fraud?
What to do if you don't understand Medicare?
Is Medicare a scam?
What are red flags for Medicare fraud?
Some red flags to watch out for include providers that: Offer services “for free” in exchange for your Medicare card number or offer “free” consultations for Medicare patients. Pressure you into buying higher-priced services. Charge Medicare for services or equipment you have not received or aren't entitled to.
What examples of Medicare fraud can you find?
Some examples include:A provider that bills Medicare for services or supplies they never gave you, like charging you for a visit you never had, or a back brace you never got.A provider that charges Medicare twice for a service or item that you only got once.More items...
Does Medicare ever contact you by phone?
Medicare generally won't call you, except in limited circumstances. One such exception is if you have called 1-800-MEDICARE and requested a return call. Medicare will never call or come to your home uninvited to sell products or services.
How does Medicare detect fraud?
Detect fraud by examining both the Medicare Summary Notice (MSN) you receive from Medicare after your claims are paid, and/or the Explanation of Benefits (EOB) you receive from your Part C and/or Part D plan. (You can also view your MSNs online by accessing your Medicare account at Medicare.gov.)
What is a major part of Medicare fraud?
Billing for physician visits and services not rendered or not medically necessary. Billing for durable medical equipment such as wheelchairs, body jackets, incontinence supplies or diabetic supplies without a doctor's prescription.
How can I find out if someone is using my identity?
at 1-877-IDTHEFT (1-877-438-4338) or go to: www.identitytheft.gov/ To order a copy of your Social Security Administration earnings and benefits statement, or to check whether someone has used your Social Security number to get a job or to avoid paying taxes, visit www.socialsecurity.gov/statement/.
Why am I getting so many phone calls about Medicare?
Phone calls Sometimes, they're selling phony products such as supplemental or prescription drug Medicare plans. The whole purpose of all of these calls is to obtain your personal information, whether that is your Medicare card number, your Social Security number, or banking information.
Why am I getting so many calls about Medicare?
Hang up. If someone calls claiming to be from Medicare, asking for your Social Security number or bank information to get your new card or new benefits, that's a scam. Don't give personal information to a caller claiming to be from Medicare.
The Societal Impact of Medicare Fraud
Sure, it may not seem like this is a huge problem, especially with only 15 total Strike Force cases in the news through half of 2018, but it’s important to realize that many of these investigations involve millions upon millions of dollars. Furthermore, this is money that has essentially been stolen from the U.S.
Individual Effects of Medicare Fraud
For starters, it’s simply maddening to think that individuals who commit these types of offenses are bringing in much more than the typical, hard-working family earns just to survive. For instance, Money reports that the median real income is $54,635 for households in Michigan and $57,259 for a household in Ohio.
Medicare Fraud: Protecting Yourself Begins by Protecting Your Card
According to Medicare.gov, you should always “treat your Medicare card like it’s a credit card.” In other words, don’t give the number out to just anybody, because there’s a chance it could be used to open up a fraudulent claim.
Even More Ways to Prevent Medicare Fraud
There are other things you can do to avoid being a victim of Medicare fraud.
What to do if You Are a Medicare Fraud Victim
If you believe that you are a victim of Medicare fraud or if you have unequivocal proof, the first thing you want to do is report it to the authorities. Medicare.gov shares that there are three ways to do this:
How to detect Medicare fraud?
Educating yourself about Medicare fraud (and about Medicare in general) is the single best way to detect Medicare fraud. When you know your enemy, you know the way they operate. You know their common ploys. When you know how Medicare works, you can better recognize when people are exploiting it.
What to do if you don't understand Medicare?
It’s been drilled into your head since you were young. If you don’t understand something, just ask! The same goes for Medicare fraud. If you notice something on your bill that you didn’t receive, if you feel as if you received care that wasn’t necessary, or you are just confused, ask your doctor or provider. You don’t want to falsely report your family doctor for fraud, but you also don’t want to let him get away with it if he is guilty. So just ask. If he is innocent, he will provide a clear explanation. If not, maybe you should report him.
Is Medicare a scam?
If someone shows up on your doorstep and claims to a representative of Medicare, just slam the door. If you pick up the phone and someone asks for your Medicare number as a part of a “health survey,” hang up. It’s a scam. And these are only two of many! There is a reason why these people are called con artists. They get creative when it comes to fraud. So, as a rule of thumb, if they ask for personal information, it’s probably fraud. And if they claim to be a Medicare representative and ask for your Medicare number, it definitely is. Medicare already has your number; they are the ones that gave it to you!
1. Know what to expect
Medicare has rules about how it interacts with Medicare beneficiaries and rules for plan representatives and insurance agents when they speak with Medicare beneficiaries about plans.
2. Keep sensitive information need-to-know
Sensitive information includes your Medicare number, Social Security number, and health information. Scammers are after these details for fraud.
3. Be wary of free or unnecessary health services
Don’t believe claims of free health services. If someone is offering free health services and needs your Medicare information, they may be planning to charge Medicare for the health services. You don’t want to participate in fraud even unwittingly, so avoid pursuing free health care.
4. Reconcile Medicare statements with personal records
Pay attention to your billing statements and reconcile them with the care you actually received. If you see any discrepancies, you can contact the hospital or doctor’s office to get more information. They can fix a billing error if there is one.
Do you suspect fraud?
Call our Insurance Consumer Hotline at 800-562-6900 or send us a message.
Report Medicare fraud and abuse
SHIBA is Washington state's Senior Medicare Patrol (www.smpresource.org) project. We can help clients prevent, detect and report Medicare and Medicaid fraud and abuse. If you have questions or suspect fraud or abuse, call 800-562-6900 and ask to speak with SHIBA.
Need more help?
Statewide Health Insurance Benefits Advisors (SHIBA) offers free, unbiased Medicare counseling.
What is the number to call for Medicare fraud?
1-800-557-6059 | TTY 711, 24/7. The above scenario is just one example of a recent type of Medicare scam. Let’s take a deeper look at Medicare fraud, including the types of scams to be aware of and how you and your loved ones can stay safe.
Why is it important to identify Medicare fraud?
Identifying Medicare fraud and abuse helps to maintain the integrity of the program, keep costs down and prosecute criminals. As a Medicare beneficiary, it is your duty to do your part in helping to combat Medicare fraud for the benefit of all. 1 Schulte, Fred.
What are some examples of Medicare abuse?
One example of Medicare abuse is when a doctor makes a mistake on a billing invoice and inadvertently asks for a non-deserved reimbursement. Medicare waste involves the overutilization of services that results in unnecessary costs to Medicare.
What is Medicare scam?
Medicare scams, like the one described above involving Medicare cards, are when individuals pose as health care providers to gather and use a Medicare beneficiary’s personal information to receive health care or money they are not entitled to.
How to protect yourself from Medicare fraud?
There are some additional things you can do and keep in mind to protect yourself from Medicare fraud: When you receive your new Medicare card in the mail, shred your old one. Also, be aware that Medicare will not contact you to verify information or to activate the card.
How long is the man in jail for Medicare fraud?
The man faces up to 10 years in prison for each of the six counts of fraud. A former health care executive in Texas admitted to her role in a $60 million Medicare fraud scheme that included overdosing hospice patients in order to maximize profits. She faces up to 10 years in prison.
What is the False Claims Act?
The False Claims Act protects the government from being sold substandard goods or services or from being overcharged. It holds people accountable who knowingly submit or cause to be submitted a false or fraudulent Medicare claim.
What is Medicare fraud?
Most Medicare fraud is an attempt to knowingly access benefits or reimbursements from Medicare that the perpetrator is not entitled to receive. This is a crime that affects everyone who pays taxes. When the perpetrators of fraud are successful, the funds they gain are no longer available to actual beneficiaries of Medicare.
How much of Medicare is lost to fraud?
Medicare fraud is one of the most common forms of health care fraud. In 2018, Former U.S. Attorney General Jeff Sessions estimated that more than 10% of Medicare funds are lost to fraud each year.
What are the types of fraud?
Provider fraud can include: 1 Billing for unnecessary services 2 Billing for services that were never provided 3 Writing unnecessary prescriptions 4 Soliciting or offering kickbacks
Is Medicare fraud a knowingly committed fraud?
A general rule is that Medicare fraud is knowingly committed. Perpetrators of fraud submit false claims or information with the intent of profiting from Medicare. If a provider bills incorrectly for services but does so due to an error or misunderstanding, it will likely not be classified as fraud.
Can Medicare call you to ask for your information?
Medicare will never call beneficiaries to ask for their Medicare information without prior permission. If you are ever in doubt, do not share your Medicare information with anyone who contacts you unsolicited, or who offers you goods or services in exchange for your Medicare number.
Is it a good idea to check your Medicare statements?
However, checking your Medicare statements and verifying that the services you received and dates you received them are accurate is a great way to monitor what claims are being submitted on your behalf. You should also be wary of providing your Medicare information to others. Guard your card!
Can Medicare fraud be considered fraud?
And, while it may not be considered Medicare fraud in the strictest sense, scammers may also attempt to impersonate Medicare employees in order to obtain personal information and commit identity theft.
What happens if you steal Medicare?
Stolen Medicare numbers may become valuable loot for criminals. These numbers can be used to bill Medicare for services and supplies that were never provided or received. The reimbursements are then pocketed.
What is Medicare Made Clear?
Medicare Made Clear is brought to you by UnitedHealthcare to help make understanding Medicare easier. Click here to take advantage of more helpful tools and resources from Medicare Made Clear including downloadable worksheets and guides.
What is summary statement for Medicare?
Medicare or your private insurance provider sends you claims summary statements detailing the health care you have received. Read them carefully. It’s important to verify that you received all the services and products that appear. Report anything that you suspect may be an error.
Is Medicare fraud a big business?
Medicare fraud can be big business for fraudsters and a big problem for taxpayers. And emergent health crises, such as the one around COVID-19, may create environments prime for scammers to take advantage of unsuspecting people.
Can criminals get your Medicare number?
Check directly with the plan provider or use the Plan Finder at Medicare.gov to verify any plan you are considering. If it’s not there, it may not be legitimate.
How to detect Medicare fraud?
Educating yourself about Medicare fraud (and about Medicare in general) is the single best way to detect Medicare fraud. When you know your enemy, you know the way they operate. You know their common ploys. When you know how Medicare works, you can better recognize when people are exploiting it.
What to do if you don't understand Medicare?
It’s been drilled into your head since you were young. If you don’t understand something, just ask! The same goes for Medicare fraud. If you notice something on your bill that you didn’t receive, if you feel as if you received care that wasn’t necessary, or you are just confused, ask your doctor or provider. You don’t want to falsely report your family doctor for fraud, but you also don’t want to let him get away with it if he is guilty. So just ask. If he is innocent, he will provide a clear explanation. If not, maybe you should report him.
Is Medicare a scam?
If someone shows up on your doorstep and claims to a representative of Medicare, just slam the door. If you pick up the phone and someone asks for your Medicare number as a part of a “health survey,” hang up. It’s a scam. And these are only two of many! There is a reason why these people are called con artists. They get creative when it comes to fraud. So, as a rule of thumb, if they ask for personal information, it’s probably fraud. And if they claim to be a Medicare representative and ask for your Medicare number, it definitely is. Medicare already has your number; they are the ones that gave it to you!
Know What to Expect
Keep Sensitive Information Need-To-Know
- Sensitive information includes your Medicare number, Social Security number, and health information. Scammers are after these details for fraud. Be sure that anyone you share this information with has a legitimate reason to have it. For example, your doctor needs your health information to give you medical advice and care. Your doctor also needs yo...
Be Wary of Free Or Unnecessary Health Services
- Don’t believe claims of free health services. If someone is offering free health services and needs your Medicare information, they may be planning to charge Medicare for the health services. You don’t want to participate in fraud even unwittingly, so avoid pursuing free health care. You’ll also want to make sure you only receive needed health care services. Receiving unnecessary care is …
Reconcile Medicare Statements with Personal Records
- Pay attention to your billing statements and reconcile them with the care you actually received. If you see any discrepancies, you can contact the hospital or doctor’s office to get more information. They can fix a billing error if there is one. If you are a client of Medicare Advocates, you can always contact the Client Service Team to help you resolve billing issues or errors. If th…