Medicare fraud, waste and abuse is a serious problem—and preventing it is something we can all help with.
Fraud doesn’t necessarily involve the person receiving the service. It can occur when healthcare providers or suppliers submit false or misleading claims to Medicare, such as billing for services or medical equipment that were never provided. Other examples include billing for equipment a person doesn’t need or “upcoding,” when a provider bills Medicare for a more expensive service or item than the one actually provided.
These fraudulent claims cost Medicare—and ultimately taxpayers—billions of dollars each year. The Federal Trade Commission estimates that Medicare losses related to fraud, errors and abuse cost taxpayers approximately $60 billion annually.
Be an Informed Healthcare Consumer
One of the simplest ways you can help detect Medicare fraud is to review your Medicare Summary Notice (MSN) or Explanation of Benefits (EOB) carefully.
Keep a simple record of your healthcare appointments, including:
- The date of your appointment
- The name of the healthcare provider
- The services or procedures you received
- Any medical equipment or supplies you received
When your Medicare statement arrives, compare it with your records. If you see a charge for a service you didn’t receive, equipment you never received, or something that doesn’t look right, don’t ignore it.
First, contact your healthcare provider or plan and ask about the charge. If it can’t be explained or corrected, you can report your concern to Medicare, the HHS Office of Inspector General, or your local Senior Medicare Patrol.
Watch Out for “Free” Medical Equipment
Fraudsters may contact Medicare beneficiaries by phone or other means and offer supposedly free medical equipment or services, such as back braces, genetic testing or other supplies.
Remember: “Free” doesn’t necessarily mean there is no cost. A company may still bill Medicare for equipment or services you don’t need or never receive. HHS-OIG specifically warns about schemes involving unnecessary or undelivered durable medical equipment, including braces and catheters.
If you receive an unsolicited offer for medical equipment or services:
- Don’t provide your Medicare number or other personal information.
- Don’t agree to receive equipment or services you didn’t request.
- Check with your doctor if you’re unsure whether something is medically necessary.
- Report suspicious solicitations to the appropriate authorities.
Be Careful With Unexpected Calls
Protect your Medicare number just as you would protect a credit card number. Medicare advises that you shouldn’t give your Medicare number or other personal information to someone who contacts you unexpectedly. If someone calls asking for your information, money, or threatening to cancel your benefits, hang up and contact Medicare directly at 1-800-MEDICARE (1-800-633-4227).
When in doubt, don’t provide information during an unexpected call. Instead, look up the organization’s official phone number independently and contact them yourself.
Where to Report Suspected Medicare Fraud
If you notice something suspicious, don’t be afraid to report it. You don’t need to determine whether something is definitely fraud before raising a concern.
1. Medicare — 1-800-MEDICARE (1-800-633-4227)
Contact Medicare about questionable charges on your Medicare statement. Have your Medicare card and information about the claim available.
2. HHS Office of Inspector General — 1-800-HHS-TIPS (1-800-447-8477)
The HHS-OIG investigates potential fraud, waste and abuse involving Medicare and other HHS programs. You can also submit a complaint online at tips.oig.hhs.gov.
3. Senior Medicare Patrol (SMP) — 1-877-808-2468
Senior Medicare Patrol programs help Medicare beneficiaries identify and report potential healthcare fraud, errors and abuse. They can help you understand a questionable charge and determine what steps to take.
The Bottom Line
Check your statements. Keep good records. Protect your Medicare number. And if something doesn’t look right, ask questions and report it.
Taking a few minutes to review your Medicare statements can help protect your benefits, your personal information and the Medicare program for everyone.
