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Medicare Fraud and How to Prevent It

Medicare Fraud

Submitting a bill to Medicare for services that were never received is fraud and is punishable by law. Medicare billing errors can happen, and while these may not constitute Medicare fraud, they can still be a costly mistake. Therefore, it’s important for you to understand how to detect Medicare fraud and Medicare billing errors and what to do in those situations.

Preventing billing errors

As with any service, billing errors can occur. The wrong code or even name may be entered by the doctor’s office. These innocent errors can cost Medicare beneficiaries extra money.

Whenever Medicare or private insurance pays a claim, the will send an Explanation of Benefits (EOB). The EOB will describe the service you received and note the codes as well as the total amount charged and paid, detailing any costs left for you to pay. It is important to review the EOB carefully. If you believe the information is inaccurate, it is important to contact the doctor immediately. A billing specialist will review your account and issue any corrections on the billing error. If a correction is made, a new EOB will be sent to you, detailing all changes made to the bill.

Medicare fraud

Unfortunately, there are some people that intentionally abuse the Medicare system. Medicare fraud can occur when someone uses another individual’s Medicare card for health services or supplies. Health care providers can also defraud the system by billing an insurer for services never received or equipment that has already been returned. This abuse system costs the system millions of dollars each year, resulting in higher premiums for beneficiaries.

Avoiding Medicare fraud

Medicare works to ensure the suppliers and providers they do business with are quality providers. They also work with several organizations to prevent and detect Medicare fraud and abuse. You can help Medicare prevent false claims in the following ways:

  • Only provide your Medicare card or claim number to your doctor or health-care providers. Never give it to anyone else.
  • Keep your medical records private, providing access only to your doctor.
  • Never ask your doctor for a medical service that you do not need.
  • Research medical services offered for free or no copay, especially when asked to provide your Medicare card. If you are unsure about your coverage, contact your Medicare plan before you receive the service.
  • Be suspicious of providers who say that the more tests they perform, the cheaper they are. Also be cautious of offers for gifts to go to a specific clinic or office.
  • Avoid providers who use telemarketing and door-to-door sales or who pressure you to buy high-priced medical services.
  • Be wary of providers who routinely waive copayments, unless this is part of your Medicare plan. Conversely, be suspicious of providers who charge a copayment for a service when your plan waives them as part of your plan.
  • Understand that the federal government and Medicare do not endorse any health-care provider.
  • Educate yourself on exactly what your specific Medicare plan covers, and be cautious of anyone who claims they know how to get Medicare to pay for a certain service that is not covered by your plan.

Reporting Medicare fraud

Report any suspicious activity to the Office of the Inspector General. Provide as many details as possible, including the abuser’s name, address, and telephone number to assist the investigation. You can report fraud in the following ways:

  • Call 1-800-HHS-TIPS (1-800-447-8477) (TTY users 1-800-377-4950) between 7AM and 8PM EST, Monday through Friday.
  • Send an email to HHSTips@oig.hhs.gov.
  • Mail a letter to Office of the Inspector General, HHS Tips Hotline, P.O. Box 23489, Washington, DC 20026-3489.
  • You can also report Medicare fraud and abuse to Medicare:
    – Call 1-800-633-4227 (TTY users 1-877-486-2048) 24 hours a day, seven days a week.
    – Mail a letter to Medicare Beneficiary Contact Center, P.O. Box 39, Lawrence, KS 66044.

You play an important role in protecting your Medicare benefits. Educate yourself on the specific details of your plan and report any suspicious activity immediately to Medicare and our provider.

The team at Seniority Benefit Group is happy to walk you through your plan and make sure you understand your benefits. Contact us today to answer any questions you may have.

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