- Centers for Medicare and Medicaid Services Report fraud online or by calling 1-800-MEDICARE (1-800-633-4227).
- Senior Medicare Patrol Program Locate your state’s Senior Medicare Patrol (SMP) Program.
- Office of the Inspector General Report fraud online or by calling 1-800-447-8477.
- State Attorneys Generals Find and contact your state attorneys general.
- State Departments of Insurance Locate your state Department of Insurance.
How to spot and report Medicare fraud?
There are many ways of Medicare fraud, but here are the most common ones:
- A health care provider bills Medicare for a service or item that you never received, or that is different from what you actually received
- Somebody uses a beneficiary’s Medicare card to receive medical services, items or supplies
- Medicare covered rental equipment was already returned, but Medicare is still billed for it
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.
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
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.
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.
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 happens if I dont report Medicare fraud?
Failure to report Medicare billing errors to the federal government is a type of Medicare fraud that can get healthcare providers – and their employees – into trouble in two ways: They could be prosecuted for criminal violations, which could result in prison time as well as fines, and they could be sued for treble ...
What are types of Medicare fraud?
A few common types of Medicare Fraud are eating away money from your clients and taxpayers: Upcoding and Unbundling, Phantom Billing, Kickbacks, and Waiving Unqualified Medicare co-pays and deductibles. Equipping clients with knowledge of these frauds and the laws to protect them could save countless hours and dollars.
What can someone do with your Medicare number?
In the unfortunate event that you fall victim to health care fraud, here's what scammers may do with your Medicare number:Identity theft or identity swapping.Double billing.Phantom billing.Upcoding.Unbundling.Bogus marketing.Impersonating a healthcare professional.Prescription forgery.More items...•
How long does Medicare fraud case take?
approximately 2-3 yearsThe Ballpark Answer When pressed, we find that a straightforward case may be intervened and settled after approximately 2-3 years, while large or complicated matters may take longer.
What is considered Medicare abuse?
What Is Medicare Abuse? Abuse describes practices that may directly or indirectly result in unnecessary costs to the Medicare Program. Abuse includes any practice that does not provide patients with medically necessary services or meet professionally recognized standards of care.
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.
What is Medicare fraud?
The Center for Medicare and Medicaid Services (CMS) states that Medicare fraud is: Intentionally billing Medicare for a service not provided. Billing Medicare at a higher rate. If a provider pays for referrals of Medicare beneficiaries.
What to do if you think there is an error in Medicare?
If you think the error is intentional or the doctor admits to an error, you’ll need to report it. An error, intentionally or unintentionally, is Medicare waste.
How to contact HHS?
Contact the HHS by mail at HHS Tips Hotline, PO Box 23489, Washington, DC 20026-348. Centers for Medicare and Medicaid Services at 1-800-MEDICARE. Contact CMS by mail at Medicare Beneficiary Contact Center, PO Box 39, Lawrence, KS 66044. You can report it by calling the CMS report hotline or submit the information online.
What is the difference between fraud and waste?
Differences between Medicare Fraud, Abuse, and Waste. Fraud requires intent to obtain payment and knowing the action is wrong. Abuse creates an unnecessary cost to the Medicare Program, without knowledge. Waste may involve intent or knowledge but could also be unintentional.
What happens if a provider doesn't follow proper medical practices?
When a provider doesn’t follow proper medical practices and unnecessary tests, they are committing Medicare Abuse. Practices that result in unnecessary costs to Medicare are considered abusing the system. Medicare abuse is a serious crime, and violators will be prosecuted.
What is Medicare program integrity enhancement?
Medicare creates the Program Integrity Enhancements to the Provider Enrollment Process rule to end fraud, waste, and abuse. Basically, Medicare expects providers and suppliers to meet specific standards to remain in the Medicare program.
How long can you go to jail for health care fraud?
Health care fraud is a federal crime with serious consequences. If convicted you could serve up to 10 years in federal prison and pay hefty fines of up to $250,000. If you cause serious bodily harm/injury to someone, 20 years could be added to your sentence. However, if death is involved, you could face life in prison.
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.
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.
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.
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.
Why report fraud?
Medicare loses billions of dollars every year to fraudulent claims. But health care fraud ultimately results in higher costs for you, too. It equals higher premiums and out-of-pocket costs, and reduced benefits and coverage.
How to spot fraud
Unfortunately, people have found many illegal ways to take advantage of Medicare. Visit the Fraud and Abuse page of the Official U.S. Government Site for Medicare to learn more about the different faces of fraud.
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 report Medicare fraud?
If you suspect a fraud has occurred, you should report it, providing as many details as you can, in any of the following ways: 1 Call Medicare’s help line at 800-633-4227. 2 Call the Office of Inspector General directly at 800‑HHS‑TIPS (800‑447‑8477, or TTY 800‑377‑4950). 3 File an online report with the Office of Inspector General.
Who investigates Medicare cases?
The Office of Inspector General of Medicare investigates and prosecutes many such cases, some of which are brought to light by Medicare beneficiaries who notice something that doesn’t look right and report it.
How to contact Medicare for a report?
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.
Do you have to identify yourself when reporting a suspected fraud?
You are not required to identify yourself when reporting a suspected fraud, although keep in mind that the investigators may want to contact you for further information in order to pursue the case properly. If your suspicion is confirmed and leads directly to the recovery of Medicare money, you may get up to $1,000 as a reward.
