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Medicare Fraud: What is it & How Can I Avoid It?

You’ve probably heard stories in the news about Medicare fraud, and how improper payments each year are estimated to be in the billions. Medicare fraud is the intentional illegal use of a person’s Medicare information for personal gain. Fraud can be committed by the beneficiary, or by someone who has access to their Medicare information, such as a doctor or salesperson. Some examples of fraud include:

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

While you can commit fraud intentionally if you’re a Medicare beneficiary, many beneficiaries are the victims. For instance, many Medicare scams begin with someone who’s not your doctor approaching you and offering a test, service or item, that they claim is completely covered by Medicare; all you need to do is give them your Medicare information. While you may receive the product or service that they were offering you, you bypassed an important part of Medicare’s process by not having your doctor provide a written order first. In this scenario, you’d be responsible for paying the bill.

Is Medicare Abuse Different than Medicare Fraud?

Medicare abuse is slightly different, but both are illegal and punishable by law. Medicare abuse refers to any practice that ends with unreasonable or unnecessary costs to Medicare. Falsified payments, such as improper billing processes or charging too much for supplies or services is considered Medicare abuse. For example, if you were receiving treatment for back pain and no longer need it, but your doctor continues to provide treatment in order to bill it to Medicare. This would be considered Medicare abuse because your doctor is providing a treatment that is no longer necessary.

How Can I Avoid Medicare Fraud and Abuse?

Being able to recognize fraud and abuse can help you from committing or becoming the victim of it. There are several steps you can take:

  • Keep your Medicare information safe
  • Don’t give your Medicare information to a person selling a test, service or item; instead, inquire about it to your doctor
  • Only buy Medicare-covered durable medical equipment from authorized dealers with a prescription from your doctor
  • Don’t let someone use your Medicare information to receive treatment or medications
  • Review your Medicare Summary Notice for any transactions that you can’t account for

How Do I Report Medicare Fraud or Abuse?

If you suspect that someone is committing Medicare fraud or abuse, here are several ways that you can report it. In order to make a report, you’ll need the following information:

  • The provider’s name or ID number
  • The 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 Medicare Summary Notice
  • Your Medicare number and your name
  • Extra information you might have about the case

You can make a report easily over the phone in one of two ways:

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

Medicare fraud and abuse negatively impact the system for which millions of Americans rely on their healthcare. You can protect yourself and prevent Medicare scams by reporting suspicious activity promptly.

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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