Medicare Fraud and Abuse

Medicare Fraud escalates, premiums increase

Medicare is a health insurance plan run by the United States Government, giving benefits to the elderly citizens of age 65 or older and younger disabled people who meet Medicare’s criteria. Medicare is the largest provider of medical benefit in America, producing at least 1 billion claims last year, boasting millions of members and a very intricate system. Unfortunately on top of this the abuse of Medicare and the constant fraud comes hand in hand.

A high percentage of health suppliers, institutions and providers of Medicare run things by the book, respecting Medicare rules. On the other hand, there’s that small percentage that is intent on committing fraud and has learnt how to con Medicare out of millions! The main people who get stung by the fraud are actually the legitimate members. They feel the effect of the fraud by the premium going up.

Most fraud against Medicare turns out to be an honest mistake. These could be a typing error, conversational misinterpretation or the form filled in incorrectly. With the vast amount of Medicare forms there’s bound to be problems. If you notice it is just a simple error, your provider should resolve things after these errors have been discussed. Nevertheless, if you then receive bills for services you never received or that you thought was free; there may be a case of Medicare fraud.

There are various forms of Medicare fraud. A few of these are: providers claiming to be a Medicare representative, billing Medicare when the service is free and scaring you into buying more expensive medical equipment.

Thankfully, the government is not giving up without a fight. They are enforcing Medicare by making sure only trustworthy decent medical suppliers, providers and institutions are used. They have also included Centers for Medicare and Medicaid Services (CMS), Medicare providers (e.g. hospitals, doctors, physicians etc), the receivers of Medicare, consumer protection agencies and federal law enforcement.

Medicare members now have the duty to look out for fraud. They should keep a close watch for extra charges, incorrect Social Security / Medicare numbers, billed services that were not provided and any thing else that looks out of the ordinary.

If you expect fraud, first let the doctor try and sort things out as it still may be a legitimate error. If the discrepancies are still not resolved then speak to the Medicare provider who dealt with the doctor’s claim. There is a hotline for the Inspector General’s office, phone 1-800-HHS-TIPS (1-800-447-8477). Please make sure you keep as much evidence as possible. Notes on conversations, documentations etc. Help stamp out Medicare fraud, its only hurts the honest folk.

Entry Filed under: Fraud and Abuse,Scams