What Is Fraud & Abuse?
Fraud occurs when someone intentionally falsifies
information or deceives Medicare. Abuse occurs when
doctors or suppliers don’t follow good medical practices,
resulting in unnecessary costs to Medicare, improper
payment, or services that aren’t 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 person’s 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 hasn’t
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
doctor’s 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 doctor’s 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, it’s 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 provider’s address on
your statement?
Many providers have an office to handle medical billing
that’s 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, it’s 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 Florida’s Medicare Fraud Hotline
There’s a toll-free hotline to report any suspicious
charges billed by providers or suppliers if:
- You’re 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.
- Don’t allow anyone, except your
medical providers, to review your medical records or
recommended services.
- Don’t contact your doctor to
request a service that you do not need.
- Don’t ask your doctor to make false
entries on prescriptions, bills, or records in order to
get Medicare to pay.
- Don’t 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.
