Medicare Fraud

Overview

Most Medicare payment errors are simple mistakes and are not the result of physicians, providers, or suppliers trying to take advantage of the Medicare system. If you have a question or concern regarding a Medicare claim submitted on your behalf, you should discuss it directly with your physician, provider, or supplier that provided the service.

The vast majority of physicians, providers, and suppliers who serve people with Medicare are committed to providing high quality care to their patients and to billing the program only for the payments they have earned.

However, there are a few individuals who are intent on abusing or defrauding Medicare, cheating the program (and in some cases the people with Medicare who are liable for co-payments) out of millions of dollars annually. Medicare fraud takes a lot of money every year from the Medicare program. People with Medicare pay for it with higher premiums. This section of the website is dedicated to helping you to help Medicare to avoid making inappropriate payments to fraudulent entities.

Medicare is taking strong action to combat fraud and abuse of the system in key areas. Our goal is to make sure Medicare only does business with physicians, providers, and suppliers who will provide people with Medicare with high quality services.

The effort to prevent and detect fraud is a cooperative one that involves:

• The Centers for Medicare & Medicaid Services (CMS)
  
  
• People with Medicare
  
  
• Providers of Medicare services including physicians, providers, and suppliers
  
  
• State and Federal Agencies such as, the Department of Health and Human Services Office of the Inspector General, the Federal Bureau of Investigation (FBI), and the Department of Justice.

The following summaries describe what information can be found here. To view any section that is of interest to you, please select any of the links below.

Fraud Detection/Prevention Tips: Offers beneficiaries useful hints on how to detect fraud. Additionally, tips on preventing fraud are also offered.

How to Report Fraud: Lists, step by step, what you need to do in order to report any suspected act of fraud.

Fraud Publications: Links you to the site's Publications Page. You will be taken directly to the section containing Fraud related publications.