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How to Avoid & Report Medicare Fraud and Abuse

How to Avoid & Report Medicare Fraud and Abuse

Trust is the primary factor in patient-physician relationships. However, the current system may be subject to fraud. Protecting your personal information must be a primary concern to fight this battle. Billions of dollars’ worth of tax-payers’ money is lost this way and it is up to the public to be alert, avoid and report medicare fraud and abuse, so the parties involved can be cracked down on and the authorities can get a perfect choke-hold on elements that pose a threat to the nation’s medical benefits.

What is Medicare Fraud?

Medicare fraud is when physicians or beneficiaries abuse the Medicare system for their own personal gains. Unnecessary costs to medicare, improper payment or unnecessary medical services are the most common things that lead to fraud. You must always carefully review your medical bills to check for unnecessary products or services being charged. This will allow you to also understand how much was paid by your Medicare or insurance and the amount owed by you. Here are certain provider cases you must beware of –

  • Your plan has service available with no copay, however the provider might waive it off or charge it.
  • Give away incentives as gifts for buying the service.
  • Try to gain your confidence by saying that they have the ability to make medicare pay for services or products not covered under your plan.
  • Try to push the sale stating that their products or services are endorsed by medicare

What is Medicare Abuse?

Medicare abuse is when a medical professional follows unethical medical practices and performs services that are not medically necessary for their own personal gains.

Tips to Avoid Medicare Fraud and Abuse

  • Keep your medicare and social security information safe. Produce it to your doctor or authorized medicare provider only.
  • Nothing good is free, so don’t accept gifts for free medical care.
  • Ask questions about the charges on your medical notices or bills, you have every right to enquire and gain the right information.
  • Know your rights to understand what a medicare provider can and cannot do.
  • Your medical records must be reviewed by your doctor or your authorized medicare providers only.
  • Do not be persuaded into seeing your doctor for products or services that you don’t need.
  • Always check your pills to see if you were given the right medication and only the ones that you are required to be under.

Report Medicare Fraud and Abuse

When in suspicion of medical fraud or abuse, you should report it as soon as possible. Agencies such as Centers for Medicare & Medicaid Services (CMS), Department of Health and Human Services (HHS), the Office of Inspector General, the Federal Bureau of Investigations (FBI), and the Department of Justice are working together to effectively curb and eradicate these instances. To report Medicare fraud and abuse you can –

  • Contact the Medicare Fraud Tip line at 1-800-HHS-TIPS (1-800-447-8477). The TTY number is 1-800-377-4950.
  • Fax a 10 page incident report to 1-800-223-8164
  • Send a 10 page incident report via E-mail – HHSTips@oig.hhs.gov
  • Mail a 10 page incident report to Office of the Inspector General HHS Tips Hotline, P.O. Box 23489, Washington, DC 20026-3489.

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