US What is Medicare Fraud How to Prevent Medicare Fraud
US What is Medicare Fraud How to Prevent Medicare
Fraud
Medicare fraud is a growing problem that costs
American taxpayers billions of dollars a year.
While law enforcement efforts to combat fraud,
waste and abuse within the Medicare program have come a long way, criminals are
still hard at work trying to find a variety of ways to defraud the government
and its U.S. taxpayers.
The Department of Health & Human Services
(HHS) established and oversees multiple health care programs, including
Medicare and Medicaid. Within HHS is the Office of Inspector General (OIG),
whose task is to make sure criminals and fraudsters do not steal your Medicare
funds.
What is Medicare fraud?
It is fraud when Medicare is billed for services
or supplies you never receive. Medicare loses billions of dollars to fraudulent
claims every year.
What are some examples of
Medicare fraud?
A healthcare provider bills Medicare for
services you never received.
A supplier bills Medicare for equipment you
never got.
Someone uses your Medicare card to get
medical care, supplies, or equipment.
A company offers a Medicare drug plan that
has not been approved by Medicare.
A company uses false information to mislead
you into joining a Medicare plan.
Why is it important to stop Medicare fraud?
Medicare fraud results in higher health care costs
for everyone. Eliminating fraud cuts costs for families, businesses, and the
federal government. It also increases the quality of services for those who
need care.
What can we do to stop
Medicare fraud?
Stopping fraud requires cooperation from
everybody—the federal government, state governments, health care providers,
insurers, law enforcement, and citizens like you.
Currently, four key programs are support the
effort to crack down on Medicare fraud:
The
Affordable Care Act
The Act,
also known as the health care reform law, includes powerful steps toward fight
health care fraud, waste, and abuse. Through its programs, the government has
recovered more than $10 billion in the last three years.
Health Care
Fraud Prevention and Enforcement Action Team (HEAT)
This joint effort between the Department of Health
and Human Services and Department of Justice brings together senior officials
to lead Medicare Strike Force teams that raise the fight against fraud to a new
level.
Senior
Medicare Patrols
The administration has added new funding for
Senior Medicare Patrols. These groups of senior citizen volunteers educate
their peers to identify, prevent, and report health care fraud.
Public-Private
Partnership to Prevent Health Care Fraud
This ground-breaking partnership unites public and
private organizations in the fight against health care fraud. The voluntary,
collaborative partnership includes the federal government, state officials,
several leading private health insurance organizations, and other anti-fraud
groups.
What successes have the anti-fraud efforts had so far?
The government recovered a historic $4.1 billion
in 2011, resulting in more than $10 billion recovered since 2008.
In its first year of implementation, the Centers
for Medicare and Medicaid’s Fraud Prevention System:
Generated leads for 538 new fraud investigations
Provided new information for 511 existing
investigations
Triggered 617 provider interviews and 1,642
beneficiary interviews
In October
2012, Medicare Strike Force operations in seven cities led to charges against
91 individuals—including doctors, nurses, and other licensed medical
professionals—for their alleged participation in Medicare fraud schemes
involving approximately $432 million in false billing.
How to Prevent Medicare Fraud?
Protecting your personal information is the best
line of defense in the fight against health care fraud and abuse. Medicare and
Medicaid lose billions of dollars each year to scam artists. You can make a
difference.
Protect your health care benefits
Don’t give your Medicare, Medicaid, or Social
Security numbers to strangers.
Remember that Medicare does not call or visit to
sell you anything.
Keep records of your doctor visits, tests, and
procedures in your personal health care journal
Site exit disclaimer (PDF - 1.8 MB) or calendar.
Save your Medicare Summary Notices and Part D Explanation
of Benefits.
Learn to protect yourself against identity theft.
Read Medicare’s lists of Do’s and Don’ts to
prevent fraud.
Detect potential errors, fraud, and abuse
Even if you do everything right, there is a chance
you could be a target of health care fraud. Keep a close eye on your medical
records to quickly detect issues.
Review your
Medicare Summary Notices and Part D Explanation of Benefits for mistakes.
You can access your Medicare account 24 hours a
day at
Compare your Medicare Summary Notices and Part D
Explanation of Benefits to your personal health care journal Site exit
disclaimer (PDF – 1.8 MB) and prescription drug receipts to make sure they are
correct.
Look for three things on your billing statement:
Charges for something you didn’t get
Billing for the same thing twice
Services that were not ordered by your doctor
Ask questions. Ask your provider whenever you:
Don’t understand your bill
Don’t think you received a service listed
Feel the service was unnecessary
If you suspect errors, fraud, or abuse—report it
If you suspect errors, fraud, or abuse when you
use Medicare—or if someone tries to sell you a product or service you don’t
need—report it. Learn what to look for, and get details about preventing and
detecting fraud.
What do I need to have to report errors, fraud, or abuse?
Before you report errors, fraud, or abuse, carefully
review the facts and have the following information ready:
The provider’s name and any identifying number you
may have.
Information on the service or item you are
questioning.
The date the service or item was supposedly given
or delivered.
The payment amount approved and paid by Medicare.
The date on your Medicare Summary Notice.
Your name and Medicare number (as listed on your
Medicare card).
The reason you think Medicare should not have
paid.
Any other
information you have showing why Medicare should not have paid.
Where do I report errors, fraud, or abuse?
To report suspected errors, fraud, or abuse, you
can contact either:
HHS Office of Inspector General
Call: 800-447-8477
TTY: 800-377-4950
Online: Report Fraud Online
Mail: HHS Tips Hotline
P.O. Box 23489
Washington, DC 20026-3489
Or
Centers for Medicare & Medicaid Services
Call: 800-633-4227
TTY: 877-486-2048
Mail: Medicare Beneficiary Contact Center
P.O. Box 39
Lawrence, KS 66044
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Friday, October 18, 2013
Tags – US Medicare Fraud Explained
