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What Is Medicare Fraud?

Unfortunately, many seniors each year fall victim to Medicare fraud. Medicare fraud is highly illegal and hurts more than just Medicare’s operations. It also hurts the senior involved. On the same note, there are some who abuse their Medicare benefits. This is also illegal and can get the beneficiary in a considerable amount of trouble. There are many ways to protect yourself from Medicare fraud and abuse.

What Is Medicare Fraud?

Medicare fraud seems like a large and complicated topic but ultimately breaks down into one main definition. Medicare fraud is the intentional illegal use of one’s Medicare information for personal gain. Some examples of Medicare fraud include:

  • Submitting false claims to get an illegitimate payout
  • The use of your own Medicare card by another individual to gain health services
  • The use of your Medicare status to get medications or services for another individual

You can potentially experience Medicare fraud in any of these ways. Also, these offenses do not have one single type of offender. They can range from individuals looking to get personal gain, to operations or groups looking to take advantage of vulnerable seniors. Regardless of who commits the crime, it can often be an expensive affair and can lead to imprisonment.

What Is Medicare Abuse?

Medicare abuse is similar but slightly different from Medicare fraud. Medicare abuse refers to any practice that ends with unreasonable or unnecessary costs to Medicare. This type of abuse frequently applies to falsified payments, such as improper billing processes or charging too much for supplies or services. Medicare abuse, if not caught in time, can sometimes lead to fraud. Abuse is also illegal and punishable by law.

How to Avoid Medicare Fraud and Abuse

The best way to avoid Medicare fraud and abuse is to keep track of all your Medicare transactions. This includes any services or goods you are getting from Medicare, any payouts, and any payment notices you get from Medicare or an insurance company. Once you have these documents, you will be able to tell if and when there are strange occurrences on your statements. As soon as you see this, it is time to report.

How to Report Medicare Fraud and Abuse

If you notice or suspect an individual or group might be part of a fraud or abuse scheme, it is your duty to report this crime immediately. There are many ways to report Medicare fraud or abuse. Before you report the crime, you must attain a specific set of information about the offense. This information includes:

  • The provider’s name or any ID number
  • Any services or items being questioned
  • The date of the fraudulent services or items
  • Total payment amount approved and paid by Medicare
  • The date that appears on your MSN
  • Your Medicare number and your name
  • A description of why you believe Medicare did not need to pay
  • Extra information you might have about the case

After you obtain all of this information, the next step is to report the fraud or abuse. To do this, you can:

  • Call Medicare directly at 1-800-MEDICARE (1-800-633-4227)
  • Report the fraud or abuse online
  • Call the Inspector General tip line at 1-800-HHS-TIPS (1-800-447-8477)

Nothing on this website should ever be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition, including decisions about the correct medication for your condition, as well as prior to undertaking any specific exercise or dietary routine.

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