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Resources
Fraud and Abuse Detection and Prevention Tips
Health care error, fraud, and abuse affect everyone. They contribute to the rising costs of health care and, in some instances, diminish the quality of care that is provided.
Most health care providers are honest and are providing the best care that they can, but the small number who aren’t find ways to steal billions of dollars from the health care system each year. Even more is lost to errors in billing that are never found.
It is in your best interest, and the best interest of all citizens, to be informed, aware, and involved in stopping and preventing error or fraud.
You should be suspicious if a health care provider tells you that:
- The test is free; he only needs your Medicare number for his records.
- Medicare wants you to have the item or service.
- They know how to get Medicare to pay for it.
- The more tests they provide the cheaper they are.
- The equipment or service is free; it won't cost you anything.
Be suspicious of providers that:
- Routinely waive co-payments without checking on your ability to pay.
- Advertise "free" consultations to Medicare beneficiaries.
- Claim they represent Medicare.
- Use pressure or scare tactics to sell you high priced medical services or diagnostic tests.
- Bill Medicare for services you do not recall receiving.
- Use telemarketing and door-to-door selling as marketing tools.
Prevention Tips
To help prevent Medicare from losing critical funds, you should report all suspected instances of error, fraud, or abuse. Whenever you receive a payment notice from Medicare, review it for accuracy. The payment notice shows what Medicare was billed for, what Medicare paid and what you owe. Make sure Medicare was not billed for health care services or medical supplies and equipment you did not receive.
The following is a list of tips to prevent fraud:
- Don't ever give out your Medicare Health Insurance Claim Number (on your Medicare card) except to your doctor or other Medicare provider.
- Don't allow anyone, except appropriate medical professionals, to
review your medical records or recommend services.
- Don't contact your physician to request a service that you do not need.
- 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.
- Be cautious of any provider who maintains they have been endorsed by the Federal government or by Medicare.
- Avoid a provider of health care 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.
Learn more about how you can become more informed or involved in this important activity by contacting the Senior Medicare Patrol Project in your state.
State/Local Contact Information
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