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Medicare Fraud

Medicare Fraud

Medicare Fraud

Every year, Medicare is cheated out of millions of dollars due to fraud. Fraud includes billing Medicare for services never provided or for services different than those provided. It also includes using someone else’s Medicare card to obtain health care.

Medicare fraud sometimes directly results in enrollees making copayments for services they did not receive. It also indirectly results in increased Medicare premiums for enrollees.

What Can I Do To Help Prevent Medicare Fraud?

Enrollees can help prevent Medicare fraud by reviewing the payment notices they receive very carefully, by refusing to provide their Medicare Health Insurance Claim Number to anyone other than their health care providers, and by restricting access to their medical records to anyone other than proper medical professionals.

What Are Some Signs Of Potential Medicare Fraud?

Although often, suspected Medicare fraud is the result of a simple misunderstanding, certain situations should trigger concern for a Medicare enrollee: (1) a representation that a diagnostic test, equipment, or service is free; (2) a statement that a provider knows how to get Medicare to pay for a service for which it does not normally pay; (3) a representation that the cost of tests decreases as the number administered increases; (4) a copayment charge for covered preventative care, such as PAP smears and influenza shots; and (5) the use of pressure to sell medical care.

What Should I Do If I Suspect Fraud?

There are two main avenues enrollees can follow if they suspect a provider has engaged in Medicare fraud. Because most suspected fraud incidents are actually misunderstandings or mistakes, an enrollee should first contact the provider who billed Medicare. If the provider cannot be contacted or if the provider is not helpful in resolving the issue, the enrollee should contact the Medicare company that paid the claim. An alternate method of following up on suspected fraud is to contact the Office of the Inspector General’s hotline, detailing what allegedly happened and when, as well as who was involved. The hotline number is (800) 447-8477.

Copyright 2011 LexisNexis, a division of Reed Elsevier Inc.

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