Medicare fraud is an unfortunate reality for many patients. Although the Centers for Medicare & Medicaid Services (CMS) and health care professionals work to prevent higher costs for patients, many institutions and individuals still commit—and get away with—fraud.
It’s important to inform patients on how to prevent Medicare fraud and advise them on how to report it should fraud happen to them.
Help prevent Medicare fraud and other abuse from happening to your patients with this information from Medicare.gov.
Check for mistakes
CMS advises patients to review their Medicare claims and check for possible mistakes or any suspicious behavior.
Patients should keep track of the dates they visit their health care providers. They also need to save their receipts and other statements to review for any errors. Errors to look for include being billed for a service they didn’t receive or being billed for the same service multiple times.
MyMedicare.gov is a free, secure service that allows patients to access their Medicare-related information whenever they’d like. And, patients can view their claims immediately after processing. 1-800-MEDICARE is another service where patients can access their Medicare information.
Look out for identity theft
CMS warns patients to safeguard their personal information to prevent identity theft.
Advise patients to keep their Social Security cards, credit cards and Medicare cards in a safe place. Remind patients to only give out their personal information to trusted insurers, physicians and other health care providers.
Know the plans
Patients can choose from a variety of Medicare health plans through private companies, independent agents or brokers. It’s important that they’re informed on how plans differ, and whether Medicare approves them or not.
Medicare.gov provides helpful information for individuals to review when choosing their plans, such as the rules Medicare plans must follow when trying to get patients to join their plan.
Report errors and possible fraud
CMS urges patients to report any suspicious behavior to the Department of Health and Human Services Office of the Inspector General (OIG). Individuals may also report the possible fraud online to the Office of the Inspector General. They can also call 1-800-HHS-Tips (1-800-447-8477) if they suspect any wrongdoing.
Patients reporting fraud must provide:
- The provider’s name and any identifying number
- The service or item in question
- The date the service was administered or delivered
- The payment approved and paid by Medicare
- The date on their “Medicare Summary Notice” (MSN)
- Their name and Medicare number
- The reason they believe Medicare shouldn’t have paid
- Any other information showing why Medicare shouldn’t have paid
Patients can be compensated
Patients may be eligible for up to $1,000 in compensation if five conditions are met.
These five conditions include:
- The suspected Medicare fraud must be specific, not general.
- The suspected Medicare fraud reported must be confirmed as potential fraud by the Program Safeguard Contractor, the Zone Program Integrity Contractor, or the Medicare Drug Integrity Contractor (the Medicare contractors responsible for investigating potential fraud and abuse) and formally referred as part of a case by one of the contractors to the OIG.
- The individual reporting the fraud is not an “excluded individual.” This means the individual didn’t participate in the reported fraud. Or, there isn’t a reward the individual qualifies for under another government program.
- The reported organization or individual isn’t already under investigation by law enforcement.
- The report leads to the recovery of a minimum of $100 in Medicare money.
Visit STOP Medicare Fraud today to find out even more ways you can help prevent fraud.
