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Medicare Fraud & Abuse

What Is Fraud & Abuse?

Fraud occurs when someone intentionally falsifies information or deceives Medicare. Abuse occurs when doctors or suppliers donít follow good medical practices, resulting in unnecessary costs to Medicare, improper payment, or services that arenít medically necessary. A complaint about the quality of care you got from a doctor, hospital, or other provider or facility is not considered fraud or abuse. If you have a complaint about your quality of care, please click here.

Examples of possible Medicare fraud are:

  • A healthcare provider bills Medicare for services you never got.
  • A supplier bills Medicare for equipment you never got.
  • Someone uses another personís Medicare card to get medical care or equipment.
  • Someone bills Medicare for home medical equipment after it has been returned.
  • A company offers a Medicare drug plan that hasnít been approved by Medicare.
  • A company uses false information to mislead you into joining a Medicare plan.

How to Report Fraud

A Federal fraud investigation is a serious and lengthy process. Before you report fraud, consider the below:

  • Did you contact the provider? What did he/she say?
    If you are uncertain about your statement, you should first contact the provider for more information.
  • Do you see an error on your Medicare Summary Notice (MSN)?
    If you see a charge on your MSN that may be wrong, call your doctor, hospital, or other provider or supplier and ask about it. Many times an error has been made in billing and can be corrected.
  • Are there incorrect dates of service?
    Be sure to check the dates of service on your MSN. Contact your provider if you remember having the service, but not on the date listed on the MSN.
  • Did you get two bills for the same services?
    Sometimes when you get services in a hospital or your doctorís office, you will get two statements: one from the doctor and one from the facility. This usually happens when you get services like labs, x-rays, anesthesia, and other services. This often happens when your doctorís office is in a hospital or if you get lab services and the doctor sends the samples to another provider for the results. Usually, when you get x-rays and other tests in a hospital, the doctor will bill for reading the test and the hospital will bill for using the equipment. If you are uncertain about your statement, itís best to contact the provider to get more information. This could be a simple billing error that the provider can correct or help you better understand.
  • Do you recognize the providerís address on your statement?
    Many providers have an office to handle medical billing thatís separate from the one patients normally visit. You should verify the practice location address (this is usually where the services were rendered). If you recognize the charges but not the address, this is usually not a fraud issue. If you are uncertain about your statement, itís best to contact the provider for more information to help you better understand.
  • Do you know the provider?
    If you recognize the charges on your statement but not the doctor, you should call your provider for help. Sometimes when you get services in a hospital, the lead doctor will sign off on all the paperwork even though you were treated by another doctor.

Contact the HHS Tips Fraud Hotline

If you suspect fraud, you can report your issue to the Office of Inspector General (OIG) HHS Tips Fraud Hotline:

Office of Inspector General (OIG) Fraud Hotline
Phone:
1-800-HHS-TIPS (1-800-447-8477)
TTY:
1-800-377-4950
Fax:
1-800-223-8164
Email:
HHSTips@oig.hhs.gov

Address:
HHS Tips Hotline
P.O. Box 23489
Washington, DC 20026-3489

You should have the following information when contacting the OIG:

  • Who committed the fraud?
  • Who are the victims?
  • What exactly did the suspect do?
  • Where did the fraud take place?
  • When did it happen?
  • How was the fraud committed?
  • Do you know why the person committed the fraud?
  • Who else has knowledge of the possible violation?

Your identity will be protected to the maximum extent allowed by the law. When reporting suspected fraud, Medicare will not use your name if you do not want them to. However, if you remain anonymous, it will be hard for Medicare and other departments to conduct their investigation because they will have no way to contact you.
 

Contact Floridaís Medicare Fraud Hotline

Thereís a toll-free hotline to report any suspicious charges billed by providers or suppliers if:

  • Youíre a Florida resident and would like to report Durable Medical Equipment fraud.
  • You got Part A or Part B services in Florida and would like to report fraud.

Please call 1-800-MEDICARE to help determine if your issue should be referred to the Florida Medicare Fraud Hotline.
 

10 Tips to Prevent Fraud

  • Never give your Medicare number to anyone, except your doctor or other Medicare provider.
  • Donít allow anyone, except your medical providers, to review your medical records or recommended services.
  • Donít contact your doctor to request a service that you do not need.
  • Donít ask your doctor to make false entries on prescriptions, bills, or records in order to get Medicare to pay.
  • Donít accept medical supplies from a door-to-door salesman.
  • Do be careful in accepting Medicare services that are represented as being free.
  • Do be cautious when you are offered free testing or screening in exchange for your Medicare card number.
  • Do be cautious of any provider who states he or she has been endorsed by the Federal Government or by Medicare.
  • Do avoid a provider of healthcare items or services who tells you that the item or service is not usually covered, but they know how to bill Medicare to get it paid.
  • Do use a calendar to track your appointments, admission and discharge dates, and what tests or X-rays you get, and compare this with the Medicare Summary Notice (MSN) you receive.

For more information on protecting yourself from fraud, visit Stop Medicare Fraud.

 

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