Every year, millions of dollars are taken from the Medicare program through deceptive practices. Medicare fraud hurts not only the program as a whole, but everyone who receives Medicare benefits. The quick guide below reveals how Medicare fraud takes place, why it affects you as an end beneficiary, and what you can do to help prevent it.



What is Medicare Fraud?

Medicare fraud occurs when false claims are made on behalf of a real beneficiary. For example, you visit a particular physician or medical clinic. They ask for your Medicare card and give you a certain amount that is due, but then bill Medicare for more than that amount. They pocket the difference. Another type of Medicare fraud is when someone bills Medicare for services or equipment that you never received or for items different from what you received. A dishonest individual might also use the Medicare card of another to receive medical services or to buy equipment. Or, someone may return home medical equipment, but continue to bill Medicare for the equipment. There are other variations of Medicare fraud, but these are the most common.

Why Should You Care?

You may ask, "Why should I care if someone else commits Medicare fraud?" There are two main reasons you should join the battle against Medicare fraud. One, your Medicare co-pay costs will increase little by little because of money lost through fraud. Just as a retail store might increase prices to cover the losses of theft, Medicare costs will increase for everyone when fraud occurs. Two, you or your loved one could be the next victim. If you frequent the emergency room, pharmacy, or doctor's office, then you are susceptible to becoming a victim of Medicare fraud. Someone may steal your Medicare card, or you might encounter a dishonest person working at a doctor's office or pharmacy. Either way, the burden of proof will fall upon you because the Medicare card and billing information will be in your name.

Detecting Medicare Fraud

Detecting Medicare fraud is easy if you keep an eye out for suspicious activities. Beware of providers that offer services for "free" when you have already given them your Medicare card. Also, if a provider offers to waive your co-payments on services routinely without checking to see if your financial situation has improved, you should be leery of this practice. Other "red flags" to watch for include pressure selling for higher-priced services, receiving Medicare bills for services you have not received, so-called "free" consultations for Medicare patients, marketing tactics being used by a provider such as telemarketing, and charges for co-payments on services that are supposed to be covered 100 percent by Medicare.

Do Not Falsely Accuse

If you suspect that a provider has committed Medicare fraud, double check with the provider to be sure it is not a simple mistake first. Sometimes human and computer errors do occur, so give your provider the benefit of the doubt from the start. If so-called "errors" seem to be happening often, then it's time to investigate! The last thing you want is to wrongly accuse your health provider, so be sure to approach suspected Medicare fraud with caution.

Before Reporting a Provider

Before you report a provider for Medicare fraud, be sure you have all the facts. You'll need all vital information about the provider including name, phone number, address, type of practice, etc. Also, you'll need to gather all the facts about the incident so you can clearly present your case. Write or type a detailed timeline of events, the item(s) or service(s) that were billed incorrectly, the date when this occurred, and any other pertinent information.

Take Preventative Measures

If you encounter a situation where you believe you or a loved one have fallen victim to Medicare fraud, report it to your local and state Medicare representatives. Also, take the following steps to help prevent this from happening to you:

1. Never give anyone your Medicare card or claim number who is not your caregiver or physician.

2. Beware of those who wish to review your medical records when they are not providing medical services to you.

3. Beware of "free" consultations and Medicare services being offered by a clinic or physician.

4. Never request medical services that you do not actually need.

5. Beware of providers that offer to get Medicare to pay for services or items that are usually not covered by Medicare.

Most of all follow your instincts. If a situation doesn't seem right, investigate to find the answers. You or your loved one can be safe from Medicare fraud if you use precaution during every medical situation. Keep in mind that criminals do not always come in dark clothing with masks on their faces. Those who commit Medicare fraud can appear to be normal caregivers or physicians, so keep your guard up any time you give out personal information such as your Medicare card.

Use this knowledge to join the fight against Medicare fraud, and help America to stay healthy!