To report suspected Medicare fraud
Medicare fraud
In the United States, Medicare fraud is the collection of Medicare health care reimbursement under false pretenses. There are many different types of Medicare fraud, all of which have the same goal: to collect money from the Medicare program illegitimately.
- By Phone. Health & Human Services Office of the Inspector General. 1-800-HHS-TIPS. ...
- Online. Health & Human Services Office of the Inspector General Website.
- By Fax. Maximum of 10 pages. 1-800-223-8164.
- By Mail. Office of 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 do you address Medicare fraud?
If you suspect Medicare fraud, do any of these: Call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048. Call the fraud hotline of the Department of Health and Human Services Office of the Inspector General at 1-800-HHS-TIPS (1-800-447-8477). TTY users can call 1-800-377-4950.
Which agency is responsible for monitoring Medicare fraud?
The Department of Health and Human Services Office of Inspector General (HHS-OIG) focuses primarily on fraud on the Medicare and Medicaid programs and the health benefits programs of the United States Public Health Service (PHS) such as the Indian Health Service.
Which of the activities are examples of Medicare fraud?
Common examples of Medicare fraud include billing for services that were not provided, billing of unnecessary services, misrepresenting dates of service, or providers of service, and paying kickbacks for patient referrals.
What are the consequences of Medicare fraud?
The criminal penalties for Medicare fraud in California include: 10 years in federal prison for each count, 20 years if the Medicare fraud resulted in serious bodily injury, and. a life sentence if it caused a patient's death.
Which is an example 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.
Which is considered Medicare abuse?
What Is Medicare Abuse? Medicare abuse is a form of healthcare fraud that most often involves submitting falsified Medicare claims. Common forms of Medicare abuse include scheduling medically unnecessary services and improper billing of services or equipment.
What factors might be 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.More items...
What is the Red Flags Rule healthcare?
The Red Flags Rule requires that organizations have “reasonable policies and procedures in place” to identify, detect and respond to identity theft “red flags.” The definition of “reasonable” will depend on your practice's specific circumstances or specific experience with medical identity theft as well as the degree ...
What is the sentence for Medicare fraud?
The criminal penalties for knowingly submitting false Medicare claims, giving kickbacks or accepting kickbacks can be significant. If a person is convicted of making fraudulent claims as described in the False Claims Act, he or she may face up to five years in prison and criminal fines as high as $250,000.
How much is the reward for reporting home healthcare fraud?
How much reward for reporting home healthcare fraud? The amount of a whistleblower reward for reporting home healthcare fraud is based upon the amount of money Medicare recovers back due to the home healthcare fraud, and the reward is between 15% and 25% of what the government collects back from the hospital or home healthcare provider ...
What are the two common fraud schemes by home healthcare companies?
Two common fraud schemes by home healthcare companies are (1) paying a doctor a kickback, either financially or through other benefits, to certify the Medicare patient as homebound, or (2) forging the physician’s signature or otherwise using false data or certifications.
How many visits a week does Medicare bill?
Some home healthcare providers bill for making 3 visits a week but only go to the Medicare recipient’s home 2 times a week. Other home healthcare fraud schemes include billing for services that they do not perform. They may provide one service, but claim to provide three services. The types of fraud schemes are endless.
What is homebound Medicare?
Medicare Home Healthcare reimbursement requires “Homebound” status. Medicare pays benefits to those who are homebound, which means that they are generally confined to their homes, including certain medical services provided at home. This means that a person is confined to the home except for infrequent or short absences or trips for medical care.
How long does Medicare cover home health?
If the home healthcare goes beyond 60 days, there must be a re-certification by the physician.
Why is Medicare paying more for home health?
Basically, more is paid for patients with more severe medical conditions because that requires more home visits and more home provided Medical services. To be covered by Medicare, any home health service must be provided under a “plan of care,” established by a doctor. If the doctor or physician does not determine that the Medicare patient is ...
What is HHA in Medicare?
The amount of payment to a Home Health Agency (HHA) depends upon what home health resource group (HHRG) the Medicare patient is classified. The HHRG group assignment is based upon things such as the diagnosis and the functional capacity and service use. Basically, more is paid for patients with more severe medical conditions because that requires more home visits and more home provided Medical services.
What is Medicare Part A and B?
Medicare Parts A and B cover intermittent or short-term home health services. These services must be provided by a Medicare-approved home health agency that works with your doctor to manage your care. To be eligible for Medicare coverage:
What does it mean to be homebound?
This means you are unable to leave your home without assistance, it requires considerable and major effort, or it is considered dangerous due to your current health condition.
Can I get Medicare at home?
To be eligible for Medicare coverage: Your doctor must determine it’s medically necessary for you to receive skilled care services at home. Skilled care services at home could include part-time or “intermittent” nurse and nurse aide visits (personal, hands-on care) and rehabilitation services, which include speech-language pathology, ...
Can you leave home for medical care?
You may leave home for medical care and some short or infrequent outings (for example, worship services) as long as you meet these conditions. Report potential home health care fraud, errors, or abuse if: You see on your Medicare Summary Notice (MSN) or Explanation of Benefits (EOB) charges for: Home health services when you did not meet Medicare’s ...
What You Need to Know
HHS-OIG’s Hotline reviews and investigates thousands of complaints each year. We recommend you review Before You Submit a Complaint to understand the type of complaints we do and do not investigate and the complaint process.
How to Contact the OIG Hotline
Start your online complaint with HHS-OIG by selecting an option below. We accept complaints about fraud, waste and abuse in Medicare, Medicaid and other HHS programs and from HHS employees, grantees and contractors who are reporting wrongdoing at HHS and its programs (whistleblowers) for the first time.
Línea Directa de Comunicación del OIG – Sección de Operaciones
Contactar la línea directa de comunicación del OIG es tan fácil. La línea directa de comunicación del OIG acepta la información y quejas de todas las fuentes sobre la posibilidad de fraude, despilfarro, abuso ó mala administración dentro de los programas del Departamento Estadounidense de Salud & Servicios Humanos (U.S.
Grant Fraud
HHS is the largest grant-making organization in the federal government, and its funding of health and human services programs touches the lives of almost all Americans. Fraud or misconduct related to the receipt or expenditure of HHS grants should be reported to our Hotline.
Contract Fraud
HHS-OIG is responsible for conducting investigations into fraud, waste, and abuse involving HHS programs, including HHS contracts. Any suspected fraudulent activities by participants on HHS contracts should be reported to our Hotline.
Whistleblower Protection Coordinator
Whistleblower disclosures by HHS employees can save lives and taxpayer dollars. These individuals play a critical role in keeping our government honest, efficient, and accountable.
Fraud Risk Indicator
HHS-OIG assessment of future risk posed by persons who have allegedly engaged in civil health care fraud.
Operation CARE
HHS-OIG has a long history of protecting the health and well-being of HHS beneficiaries, including residents in long-term care facilities such as nursing homes. HHS-OIG collects and investigates tips and complaints about fraud, waste, and abuse in these facilities.
How to Report Health Care Fraud
Call your insurance company immediately if you suspect you may be a victim of health insurance fraud.
Other Quick Links
For an overview of what constitutes Medicare fraud or if you suspect that fraud is being committed against Medicare, please click here . To report Medicaid fraud, click here. For a full list of government agency contacts and resources, click here.
