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Medicare Fraud
The following information and fraud prevention tips
are from the Health Care Financing Administration.
Medicare fraud includes, but is not limited to:
- Billing for more expensive services at a higher service than was
provided.
- Falsifying certificates of medical necessity, plans of treatment,
and medical records to justify payment.
- Billing for services not furnished.
- Soliciting, offering, or receiving a kickback.
- Billing, separately for services that should be included in a single
fee.
- Misrepresenting the diagnosis to justify payment.
Protect yourself against health care fraud:
- Never give your Medicare or Medicaid number over the telephone or to
people you do not know.
- Beware of health care providers and suppliers that use telephone
calls and door-to-door selling as a way to sell you goods or services.
- Be suspicious of companies that offer free medical equipment or
offer to waive your co-payment without first asking about your ability
to pay.
- Beware of health care providers who say they represent Medicare or a
branch of the federal government, or providers who use pressure tactics
to get you to accept a service/product.
You should be suspicious if the provider tells you:
- The test is free: they only need your Medicare number for their
records.
- Medicare wants you to have the item or service.
- The more tests provided, the cheaper they are.
- The equipment or service is free; it won't cost you anything.
Be suspicious of....
- Home health providers that offer non-medical transportation services
or housekeeping as Medicare approved services.
- Ambulance companies that bill Medicare for non-emergency trips.
- Suppliers that bill Medicare for medical equipment for beneficiaries
in nursing homes.
- Physicians that give the wrong diagnosis on the claim form so
Medicare will pay.
Reporting Medicare fraud and abuse:
If you have a questionable charge on your bill, call the
provider, your Fiscal Intermediary (for part A bills) or your
Medicare carrier (for part B bills). If you believe that a health care
provider may be cheating or abusing the Medicare program, call the
Medicare carrier or intermediary that sent you the payment notice.
After you call the Medicare carrier or Fiscal Intermediary, you
may also call the Inspector General's hotline at 1-800-HHS-TIPS
(1-800-447-8477), or TTY for the hearing and speech impaired:
1-800-377-4950.
Article taken Ohio Crime Prevention Association Info link
Newsletter as taken from Triad, September 1999.
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