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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