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MMA 2003

Medicare Fraud

Detection and Prevention Tips

What is Fraud?

Medicare fraud is purposely billing Medicare for services that were never provided or received.

Some examples of Medicare fraud include:

  • Billling Medicare or another insurer for services or items you never got.

  • Billing Medicare for services or equipment which are different from what you got.

  • Use of another person’s Medicare card to get medical care, supplies, or equipment.

  • Billing Medicare for home medical equipment after it has been returned.

Detection Tips

You should be suspicious if the provider tells you that:

  • The test is free; he only needs your Medicare number for his records. NOTE: For clinical laboratory tests, there is no co-payment and a provider may in good faith state that the test is free, since there is not cost to the person with Medicare.

  • Medicare wants you to have the item or service.

  • They know how to get Medicare to pay for it.

  • The more tests they provide the cheaper they are.

  • The equipment or service is free; it won't cost you anything.

Be suspicious of providers that:

  • Charge co-payments on clinical laboratory tests, and on Medicare covered preventive services such as PAP smears, prostate specific antigen (PSA) tests, or flu and pneumonia shots.

  • Routinely waive co-payments on any services, other than those previously mentioned, without checking your ability to pay.

  • Advertise "free" consultations to People with Medicare.

  • Claim they represent Medicare.

  • Use pressure or scare tactics to sell you high priced medical services or diagnostic tests.

  • Bill Medicare for services you did not receive.

  • Use telemarketing and door-to-door selling as marketing tools.

Prevention Tips

To help prevent Medicare fraud, you should report suspected instances of fraud. Whenever you receive a payment notice from Medicare, review it for errors. The payment notice shows what Medicare was billed for, what Medicare paid and what you owe. Make sure Medicare was not billed for health care services or medical supplies and equipment you did not receive.

The following is a list of tips to prevent fraud:

  • Don't ever give out your Medicare Health Insurance Claim Number (on your Medicare card) except to your physician or other Medicare provider.

  • Don't allow anyone, except appropriate medical professionals, to review your medical records or recommend services.

  • Don't contact your physician to request a service that you do not need.

  • Do be careful in accepting Medicare services that are represented as being free.

  • Do be cautious when you are offered free testing or screening in exchange for your Medicare card number.

  • Do be cautious of any provider who maintains they have been endorsed by the Federal government or by Medicare.

  • Do avoid a provider of health care items or services who tells you that the item or service is not usually covered, but they know how to bill Medicare to get it paid.

It is in your best interest and that of all citizens to report suspected fraud. Health care fraud, whether against Medicare or private insurers, increases everyone's health care costs, much the same as shoplifting increases the costs of the food we eat and the clothes we wear. If we are to maintain and sustain our current health care system, we must work together to reduce costs.

Correction to previous information concerning ambulance services:
In a previous fraud flyer intended to assist beneficiaries in recognizing fraudulent practices in the Medicare program, we advised beneficiaries to be suspicious of ambulance companies that bill for trips that are not emergency in nature. That statement is misleading. Non-emergency ambulance services are covered by the Medicare program when reasonable and necessary. We apologize for any misunderstandings or confusion that may have resulted from this statement.

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Fraud Detection / Prevention Tips

How to Report Fraud and Abuse

Fraud and Abuse Publications


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