Medicare fraud is a serious issue that you need to report. The Center for Medicare and Medicaid services says fraud can cost taxpayers billions of dollars. It can also interfere with the health of Medicare beneficiaries.
That’s taxpayer money that’s going into the hands of unethical providers. Reporting Medicare fraud is as simple as making a phone call.
If you know Medicare fraud, waste or abuse that’s happening, it’s vital that you report the incident. As citizens, it’s our job to be courageous and prevent the injustice from occurring again.
Besides, sometimes there is a reward available to the person that reports Medicare fraud, waste or abuse.
Reporting Medicare Fraud
Medicare fraud is the term used in describing someone, usually a doctor, knowingly billing Medicare for a service that was never done.
Of course, accidents happen, and mistakes can be made.
Doctors and medical coders are only human.
Some codes may have a similar description, although, they can be very different in cost.
Human errors that happen once, are innocent and not considered fraud.
If you notice something that may be an error, talk with your provider. They may be able to explain why it’s correct or fix the error.
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
Medicare fraud is very serious, it’s not human error, it’s highly illegal and it involves doctor or beneficiaries abusing the system for their own benefit. Report Medicare Fraud as soon as possible.
If a doctor ever says one of these things to you, report it immediately:
- The more tests that are done, the less you pay out-of-pocket
- Offers you a gift to get you to use their services
- Waives a copayment or says the co-payment is higher on a no-copay plan
- States you can receive coverage on a non-covered service
- The service or product Medicare endorses
If you have Medicare, you can look through your Medicare Summary Notice, and compare your statements as well as receipts from your providers.
So, you noticed a bill for a product or service not applicable? Contact the office to be sure of the mistake. If an error occurred, that’s Medicare abuse.
Reporting Medicare Abuse: Find and Avoid It
When a provider doesn’t follow proper medical practices and issues unnecessary test, they are committing Medicare Abuse. Practices that result in unnecessary costs to Medicare are considered Abuse.
Medicare Abuse is a serious crime and violators will be prosecuted.
Abuse can be found when billing for unnecessary services, or services that aren’t medically necessary occur.
If you’re overcharged for services or supplies, then you’re a victim of Medicare abuse. However, if a provider misuses billing codes to increase reimbursement, then the doctor is committing Medicare abuse.
Medicare won’t use your name during the investigation of Medicare fraud, waste or abuse if you don’t want them to, you can remain anonymous.
Identifying & Reporting of Medicare Waste
Waste includes practices that result in unnecessary costs to the Medicare program, like overusing services. Waste is the misuse of resources.
You need to report any Medicare fraud, waste or abuse as soon as possible.
Some examples of waste include:
- Prescribing more medications than necessary for one specific condition
- Ordering excessive lab tests
- Conducting excessive office visits
If you know of someone misusing resources, understand that this is a serious offense. Any violators will be prosecuted because it costs taxpayers billions of dollars when waste occurs.
Penalties for violating the laws against fraud, waste, and abuse include:
- Civil prosecution
- Civil monetary penalty
- A criminal conviction, fines, or both
- Loss of professional license
- Exclusion from all Federal health care program participation
As a Medicare beneficiary, looking at your bills to check for fraud is your responsibility. If you think there may be an error, contact the doctor’s office.
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.
Reporting Medicare Fraud, Waste, and Abuse
There are differences between fraud, abuse, and waste. However, the biggest difference is intent and knowledge.
- 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.
You can call the Medicare fraud hotline or report the fraud by contacting one of these organizations:
- Department of Health and Human Services (HHS) Office of Inspector General (OIG) Medicare fraud hotline at 1-800-HHS-TIPS (1-800-447-8477) you can contact them 24 hours a day, 7 days a week
- Contact the HHS by mail at HHS Tips Hotline, PO Box 23489, Washington, DC 20026-348
- Centers for Medicare and Medicaid Services (CMS) at 1-800-MEDICARE (1-800-633-4227) they are available 24 hours a day, 7 days a week
- Contact CMS by mail at Medicare Beneficiary Contact Center, PO Box 39, Lawrence, KS 66044
How to Report Medicare Fraud
If you’re reporting Medicare fraud, waste or abuse it’s helpful to have some of your information ready.
- Medicare number
- Provider information
- Information about the service that was supposedly provided
- and the reason you think fraud was committed
If a reported Medicare fraud leads to the recovery of funds, Medicare may provide a reward. If you or someone you know suspects fraud, waste or abuse, report it immediately.