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Useful Resources
You Can Make A Difference
As part of a growing number of retired persons in society today, you take comfort in knowing that the medical services you need will be there when you need them. The vast majority of health care professionals are working to provide the best care that they can. However, due to the practices of a small number of dishonest individuals, Medicare and Medicaid are being drained of valuable resources - resources that you rely on when it comes to your health and the health of your loved ones.
Audits by the Office of Inspector General reveal that $1 out of every $7 spent on Medicare and Medicaid is lost due to improper payments. This problem affects all Americans. It affects those who depend on these programs by diminishing the quality of treatment they receive. It affects families and caregivers by decreasing the funding available for important health care supports. And it affects everyone who pays taxes by wasting billions of dollars per year.
What Exactly Are Fraud and Abuse?
Fraud occurs when an individual or organization deliberately deceives others in order to gain some sort of unauthorized benefit. Medicare or Medicaid fraud generally involves billing for services that were never provided, or billing for a service at a higher rate than is actually justified.
Health care abuse occurs when providers supply services or products that are medically unnecessary or that do not meet professional standards.
There are many different types of Medicare and Medicaid fraud and abuse. They include:
- Billing for services or supplies not provided.
- Providing the same equipment for all patients, whether it is need or not.
- Incorrectly reporting diagnoses, procedures, medications, or equipment to get a higher payment.
- Billing for individual psychotherapy when group counseling was provided.
- Billing for brand-name prescriptions when generic drugs were provided.
- Kickbacks or bribes; for example, payments or gifts in return for medical services or patient referrals.
- Using another person’s Medicare card to obtain medical care.
- Billing Medicare or Medicaid and a private insurance program for the same procedure.
- Routinely waiving the deductible or coinsurance.
- Labs offering free diagnostic tests to get insurance numbers, and then using those numbers to bill for tests never provided.
For further information and assistance about what you can do to protect yourself, your family, and your neighbors from Medicare and Medicaid fraud and abuse, contact the Senior Medicare Patrol Project located in your state.
State/Local Contact Information
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