Medicare Fraud Costs Taxpayers Millions: How to Prevent It

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No one knows for sure how much Medicare fraud costs the American people, because much of the scams go undetected. What is known is this: at least $2.3 billion in false claims have been billed since 2007, when the Medicare Fraud Strike Force was formed by the Department of Justice (DOJ) and the department of Health and Human Services (HHS).

Fraud costs the Medicare Program millions of dollars every year, which results in higher health care costs for everyone. The Fraud Strike Force says everyone you can do your part to stop fraud by reviewing Medicare statements to make sure Medicare is not charged for items or services that you or your elderly parents did not receive.

Here are some tips, provided by Medicare.

What Is Medicare Fraud?

Some examples of possible Medicare fraud are:

  • A healthcare provider bills Medicare for services you never received
  • A supplier bills Medicare for equipment you never received
  • Someone uses another person's Medicare card to get medical care, supplies 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 Detect Medicare Fraud

Be suspicious if a provider tells you that:

  • They know how to get Medicare to pay for an item or service
  • The more tests they provide, the cheaper they are
  • Equipment, like wheelchairs or seat lifts, is free

Be suspicious of providers who:

  • Do not charge copayments or coinsurance without first checking on your ability to pay
  • Advertise free consultations to people with Medicare
  • Claim they represent Medicare or a branch of the Federal Government
  • Use pressure or scare tactics to sell you high-priced medical services or diagnostic tests
  • Bill Medicare or another insurer for services or items you did not get
  • Bill Medicare for services or equipment that are different from what you received
  • Bill Medicare for home medical equipment after you returned it
  • Offer non-medical transportation or housekeeping as Medicare-approved services
  • Put the wrong diagnosis on the claim so Medicare will pay
  • Bill home health services for people who are not confined to their home
  • Ask you to contact your doctor and ask for a service or supplies that you do not need
  • Charge copayments on clinical lab tests and on Medicare-covered preventive services such as PAP smears, PSA tests, or flu and pneumonia shots
  • Offer you payment or gifts to go to clinics or offices
  • Offer a free power wheelchair, scooter, or other equipment
  • Want you to use their doctors
  • Offer to waive Medicare Part B coinsurance or deductible
  • Call you when you did not give them your phone number
  • Alter claims to receive higher payment
  • Charge a restocking fee or a pickup fee for equipment or supplies that you are returning

How to Prevent Medicare 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 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
  • Be careful in accepting Medicare services that are represented as being free
  • Be cautious when you are offered free testing or screening in exchange for your Medicare card number
  • Raise a red flag when any provider states he or she has been endorsed by the Federal Government or by Medicare
  • 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
  • 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

What to Do if You Suspect Medicare Fraud

Gather the following information, and then contact the Office of the Inspector General:

  • The provider's name and any identifying number you may have
  • The item or service you are questioning
  • The date on which the item or service was supposedly furnished
  • The amount approved and paid by Medicare
  • The date of the Medicare Summary Notice
  • The name and Medicare number of the person who supposedly received the item or service
  • The reason you believe Medicare should not have paid
  • Any other information you may have showing that the claim for the item or service should not have been paid by Medicare

Report suspected fraud to the Inspector General by calling 1-800-447-8477 or emailing HHSTips@oig.hhs.gov.

For more information on preventing Medicare fraud, visit the Stop Medicare Fraud website

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4 Comments

As a physician misbehavior investigator, I see enormous flaws in any so-called 'health care reform’ that refuses to address the off-the-chart volume of doctor-related mischief. How is it that this subject is so deftly, consistently sidestepped?

Monstrous fraud; more than one million unwarranted surgeries; drug-pushing beyond reason. Our health care system provides a fertile garden for some seriously nasty critters. Chew on these points for a minute:

1. U.S. DOJ: “the estimated law enforcement cost to police & try criminal doctors and medical fraud, is 1/2 TRILLION dollars annually.” Let's all stop and stare at that number again: $500,000,000,000.

2. 11,000 physicians found criminally guilty of serious misbehavior in the last decade. Five times as many civil or ethics hearings resulted in sanctions.

3. 2009 - 2,490 doctors convicted of egregious acts.

4. 2010 - The tally for last year is now in - 2,318 MDs found "Guilty" of felonies.

When a single New York surgeon can perform & bill for 10,000 unwarranted eye operations on the mentally ill; when a team of heart surgeons can cut open 750+ healthy chests to pad their own bank accounts, AT ONE HOSPITAL; When the Michigan medical board chairman utters the words, "Yes, it can take five years to remove a child molester MD," then the only line that comes to mind was spoken on Apollo 13:

"Houston, we have a problem."

Until we weed out the lab coat lunacy and the jaw-dropping volume of doctor-theft, any other talk of “reform” is whistling past the graveyard. And I suspect that when/if that wondrous day arrives, a surprising amount of money will exist, that doesn't exist now.
I sposted this question but I would like you to look at it if you think fraud of double billing Medicaid for services they had been paid for since they were told they could retro the billing (I'm sure Texas Medicaid did not know my father was paid in full through May 2010).

Is it right for a nursing home to bill my father's medical and AARP insurance during the pending period for Medicaid; this is billing
for which the nursing home sent him to the hospital (due to a bladder infections) to meet the 3 day period so when he came back they were able to bill at the Skilled Nursing rate; this happen three times. He was admitted 12-2009 very quickly at the nursing home when they saw he had AARP and Medical. Medicaid was denied in April 2010; at this time all charges had were billed and paid in full with the added Skiled Nursing fees by Medical and AARP. Then the Nursing home refiled for medicaid in April 2010, in June 2010 my father was approved with Medicaid who posted it could be retroactivated. The nursing home (eventhough they were paid in full with my fathers own insurances) went back and billed Medicaid form December 2009 as if they had not received a dime; then are now, asking us to pay the monthly retro from December 2009 as if they never were paid. Also, he was denied in April, why are they entitled to Start in December and not April 2010 when the second application was made? My concern is this, why should my family have to pay all of the retro monthly (over 1,000 a month starting retro of 12-2009) payments when my fathers insurance paid before he was orig. denied? And why would Medicaid be bill too? It looks like double dipping here? If I had not applied for medicaid I would not have to pay a dime for my father was in and out of the hosiptals during his medicaid applicatio so his insurances paid.

Also...the nursing home has ask us to sign a form H1200-A, they said it is a yearly recertification; but when I looked up the form it is a program transfer? Are they planing to transfer him out of his nursing home?

Please help, I thank you for your help
My father has a entire small book with evidence of Medicare fraud and he has written senators, the white house, and many others. I have personally written them too and wrote many news stations and reporters and no one responds. He contacted medicare and the lady on the other end of the phone said and I quote " What do you care its not your money". This is part of the problem complete stupidity. When a company turns in hundreds of dollars for medical tests that never happened, when a company turns in tests that were supposedly ordered by a deceased doctor, what would you call it? But they want to give a 90 yr old woman a hard time about the one medicine that got her functioning again. She had become completely disabled, my Dad who is 85 even had to bathe her and take her to the bathroom. She was in complete pain and could barely move. When I stepped in and contacted the doctors then some action started happening- they removed one medicine and put her on another medicine and she is now a functioning human being- as much as someone can be for 90. This woman worked until she was 85 years old. Now they want her to be re-certified for this medicine.I could give many more examples.