Medicare Fraud Prevention And Fraud-Finding Incentive
Program
Medicare provides medical coverage for citizens aged 65
years or older and certain disabled persons younger than 65 years. It is
the U.S. Government's health insurance plan for elderly Americans.
Medicare is the nation's largest provider of managed care with over one
billion claims submitted each year. Medicare fraud and abuse is
inevitable due to the sheer volume of claims and the tens of millions of
members.
Nearly all Medicare providers, suppliers, and play by the rules.
Unfortunately there are dishonest people who have determined how to
commit Medicare fraud. This abuse costs the Medicare system millions of
dollars annually. Medicare must pass the costs on to honest members by
raising premiums.
Most Medicare mistakes are not Medicare fraud, and
can be fixed with a phone call. If not, here are some tips on how to
spot Medicare fraud.
Some Medicare fraud warning signs include:
- The medical provider wants your Medicare number even if the test
is free.
- The service is not covered by Medicare but your provider tells you
that they know how to get reimbursed for it.
- The provider tries to convince you that more tests are better, or
that more tests will cause you to pay less for the visit.
- The provider tells you that the medical equipment or service is
free, when you know there is a charge for it.
Additional signs of Medicare fraud include:
- Your provider charges you a co-payment for laboratory services
(which are 100% covered by Medicare).
- The provider tries to entice new patients by proclaiming free
consultations for Medicare patients.
- The provider claims to be a Medicare representative.
- The provider routinely waives your co-payments for services which
require them, without even inquiring about your ability to pay.
- High-pressure sales or scare tactics are used to get you to
purchase expensive services or equipment.
- Your statement bills Medicare for services you did not receive.
Here are tips on how to help prevent Medicare fraud: never give your
Medicare insurance number to anyone but your medical provider, only
appropriate medical officials should see your medical records, don't
exchange your Medicare card number for free services, be wary of
providers who claim that they can get reimbursed for
non-reimbursable services, and don't believe a provider who claims
to be endorsed by Medicare or the government.
Rewards For Medicare Fraud Reporting
There is a Medicare Incentive Reward program for reporting Medicare
fraud and abuse. If the information you provide leads to a Medicare
fraud recovery of at least $100, the initial complaint was received
after July 8, 1998, and the complaint is not related to an ongoing
investigation, you may be eligible for a reward.
Medicare fraud investigations may take months or even years. If you
are eligible for a Medicare fraud reward, you may receive $1,000 or
10% of the recovered funds, whichever is less.
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