TYPES OF MEDICARE FRAUD
When an individual or organization seeks to collect Medicare health care reimbursement under false pretenses, it is Medicare fraud. The fraud is usually carried out in one of the following three ways:
- Phantom Billing: The medical provider bills Medicare for unnecessary procedures, medical test, or procedures OR procedures or tests are never performed. Sometimes unnecessary equipment or used equipment is billed as new.
- Patient Billing: A patient who colludes in the fraud provides his or her Medicare number for payment. The provider bills Medicare, and the patient is told to confirm that he or she received the treatment.
- Upcoding scheme and unbundling: Inflating bills by using a billing code that indicates the patient needs expensive procedures.
Billing fraud can be prevented through carefully checking your bills.
EXAMPLES OF MEDICARE FRAUD
Fraud costs the Medicare Program millions of dollars every year. You pay for it with higher health care costs. Fraud schemes may be carried out by individuals, companies, or groups of individuals. Be suspicious of doctors, health care providers, or suppliers that do any of the following:
- Bill home health services for patients who are not confined to their home.
- Bill home health services for patients who still drive a car.
- Bill Medicare for medical equipment for people in nursing homes.
- Bill Medicare for tests you received as a hospital inpatient or within 72 hours of admission or discharge.
- Bill Medicare for a power wheelchair or scooter when you don’t meet Medicare’s qualifications.
- Bill Medicare for services you never received or a diagnosis you do not have.
- Bill Medicare for home medical equipment after it has been returned.
- Use telephone or door-to-door selling techniques.
- Use pressure or scare tactics to sell you expensive medical services or diagnostic tests.
- Tell you how to get Medicare to pay for the item or service and all that is needed is your Medicare number.
- Tell you the more tests provided, the cheaper the tests become in the future.
Other signs of fraud:
- Equipment or service is offered free and you are then asked for your Medicare number for “record keeping purposes”.
- “Free” consultations offered to people with Medicare.
- People call or visit you and say they represent Medicare or the Federal government.
- A person or organization offers non-medical transportation or housekeeping as Medicare-approved services.
- Someone uses another person’s Medicare card to get medical care, supplies, or equipment.
- A company offers a Medicare drug plan that has not been approved by Medicare.
- A company uses false information to mislead you into joining a Medicare plan.
PROTECT PERSONAL INFORMATION
You can help prevent Medicare fraud by protecting your Medicare and Social Security Numbers. It is illegal to let anyone borrow or pay to use your Medicare ID card or your identity.
If your Medicare card is lost or stolen, report it right away. Call Social Security at 1-800-772-1213 (TTY 1-800-325-0778) for a replacement. If you get benefits from the Railroad Retirement Board, call 1 877 772 5772, or visit www.rrb.gov.
Don’t give your information out over the internet or to anyone who, uninvited, comes to your home or calls you. Only give personal information to doctors or other providers approved by Medicare. If you are not sure a provider is approved by Medicare contact 1-800-MEDICARE (1-800-633-4227) or 1-877-486-2048 (TTY users)
Check Your Medical Bills, Explanation of Benefits, and Credit Reports. If you do not understand your Medicare Summary Notice, get help reading it.
REPORT MEDICARE FRAUD
Office of Inspector General.
Centers for Medicare and Medicaid