Medicare Fraud Costs Taxpayers Millions: Ways to Prevent It

By Marlo Sollitto, AgingCare.com contributing editor

No one knows for sure how much Medicare fraud costs the American people, because much of the scams go undetected. What is known is this: at least $2.3 billion in false claims have been billed since 2007, when the Medicare Fraud Strike Force was formed by the Department of Justice (DOJ) and the department of Health and Human Services (HHS).

Fraud costs the Medicare Program millions of dollars every year, which results in higher health care costs for everyone. The Fraud Strike Force says you can do your part to stop fraud by reviewing Medicare statements to make sure Medicare is not charged for items or services that you or your elderly parents did not receive.

4 Scams to Look Out For During Medicare Open Enrollment

Here are some tips, provided by Medicare.

Know What Medicare Fraud Is

Some examples of possible Medicare fraud are:

  • A healthcare provider bills Medicare for services you never received
  • A supplier bills Medicare for equipment you never received
  • Someone uses another person’s Medicare card to get medical care, supplies or equipment
  • Someone bills Medicare for home medical equipment after it has been returned
  • A company offers a Medicare drug plan that hasn’t been approved by Medicare
  • A company uses false information to mislead you into joining a Medicare plan

Related:
“Spending Down” to Medicaid: One Caregiver’s Personal Journey
Medicaid’s ‘Cash and Counseling’ Allows Pay for Family Caregivers
What’s the Difference Between Medicare and Medicaid?

Medicare Fraud Costs Taxpayers Millions: How to Prevent It originally appeared on AgingCare.com


Know How to Detect Medicare Fraud

Be suspicious if a provider tells you that:

  • They know how to get Medicare to pay for an item or service
  • The more tests they provide, the cheaper they are
  • Equipment, like wheelchairs or seat lifts, is free

5 Illegal Insurance Practices During Medicare Open Enrollment

Be suspicious of providers who:

  • Do not charge copayments or coinsurance without first checking on your ability to pay
  • Advertise free consultations to people with Medicare
  • Claim they represent Medicare or a branch of the Federal Government
  • Use pressure or scare tactics to sell you high-priced medical services or diagnostic tests
  • Bill Medicare or another insurer for services or items you did not get
  • Bill Medicare for services or equipment that are different from what you received
  • Bill Medicare for home medical equipment after you returned it
  • Offer non-medical transportation or housekeeping as Medicare-approved services
  • Put the wrong diagnosis on the claim so Medicare will pay
  • Bill home health services for people who are not confined to their home
  • Ask you to contact your doctor and ask for a service or supplies that you do not need
  • Charge copayments on clinical lab tests and on Medicare-covered preventive services such as PAP smears, PSA tests, or flu and pneumonia shots
  • Offer you payment or gifts to go to clinics or offices
  • Offer a free power wheelchair, scooter, or other equipment
  • Want you to use their doctors
  • Offer to waive Medicare Part B coinsurance or deductible
  • Call you when you did not give them your phone number
  • Alter claims to receive higher payment
  • Charge a restocking fee or a pickup fee for equipment or supplies that you are returning

Related:
How Can My Elderly Parent Qualify for Medicaid?
Assets You Can Have to Still Qualify for Medicaid
The Affordable Care Act is Constitutional. Now What?

Medicare Fraud Costs Taxpayers Millions: How to Prevent It originally appeared on AgingCare.com


Know How to Prevent Medicare Fraud

Here is a list of tips to prevent fraud:

  • Never give your Medicare number to anyone, except your doctor or other Medicare provider
  • Don’t allow anyone, except your medical providers, to review your medical records or recommended services
  • Don’t ask your doctor to make false entries on prescriptions, bills, or records in order to get Medicare to pay
  • Don’t accept medical supplies from a door-to-door salesman
  • Be careful in accepting Medicare services that are represented as being free
  • Be cautious when you are offered free testing or screening in exchange for your Medicare card number
  • Raise a red flag when any provider states he or she has been endorsed by the Federal Government or by Medicare
  • Avoid a provider of healthcare 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
  • Use a calendar to track your appointments, admission and discharge dates, and what tests or X-rays you get, and compare this with the Medicare Summary Notice (MSN) you receive

Your Parent Could Be a Victim of Identity Theft and Not Know It

What to Do if You Suspect Medicare Fraud

Gather the following information, and then contact the Office of the Inspector General:

  • The provider’s name and any identifying number you may have
  • The item or service you are questioning
  • The date on which the item or service was supposedly furnished
  • The amount approved and paid by Medicare
  • The date of the Medicare Summary Notice
  • The name and Medicare number of the person who supposedly received the item or service
  • The reason you believe Medicare should not have paid
  • Any other information you may have showing that the claim for the item or service should not have been paid by Medicare

Related:
How Life Insurance Policies Affect Medicaid Eligibility
Medicaid Might Make You Pay Them Back Mom’s Nursing Home Costs
What Happens If You Miss Medicare’s Annual Enrollment Deadline?

Medicare Fraud Costs Taxpayers Millions: How to Prevent It originally appeared on AgingCare.com

24 comments

Edward M.
Edward M.4 years ago

Perhaps a universal healthcare system is needed instead, whereby the hospitals, medical practioners, et al., are all brought under one umbrella in providing healthcare for all Americans, whatever their circumstances.
After all, if you can afford to spend the extraordinary amounts of money in maintaining your military machine, then you certainly can afford this. However, if it comes down to a choice, which of these two would you really want to enhance your wellbeing?
We have a system over here in the UK (currently under threat from our current Coalition Government) which provides just that, a health system free at the point of use.
Fuller details of how this socially inclusive service came into being can be found by typing in 'Aneurin Bevan' on your browser.

Lin Moy
Lin M4 years ago

I get so much med. mail it is hard to read it all. If you understand some of it, you are lucky.

Lynn C.
Lynn C.4 years ago

Have you ever tried to make sense of the bills you're sent from hospitals and doctors? It's a maze of coding and 16-letter words. Pretty easy to scam people, especially those who are old and confused and can't see well to begin with.

Rita White
Rita White4 years ago

thanks for sharing

Laurie D.
Laurie D.4 years ago

Something that's a bit more subtle and less likely to be found is all the unneccessary surgery done on the elderly. One lady I knew was in poor health, diabetic and slightly overweight and her doctor had her undergo gastric bypass surgery. The complications killed her! Later it was documented this surgery was completely unneccessary... I think there is quite a bit of this sort of abuse!

Sheila D.
Sheila D.4 years ago

Most of this involves paying attention, which the majority of people try to do. Unfortunately, there are many people who are past being able to figure out their treatments, much less their bills, and so are taken advantage of. We hear about the elderly being abused and robbed by relatives, who are probably participants in Medicare fraud, also. Doctors who are involved in fraud should lose their license, be fined, AND go to jail. Everyone else should be fined and go to jail. And the benefits they get in jail is a whole other subject...

Teresa Wlosowicz
Teresa W.4 years ago

thank you

Maureen L.
Maureen Leibich4 years ago

I make sure that everything is legit on my summaries. I see several doctors--one once a year; one once every two years; one several times a year--and it would be easy for fraud to get through. Therefore, I double check everything. I haven't found anything yet, so I guess I've been lucky.

SP P.
Molly D.4 years ago

We do know approx. the amount of fraud. The US govt. estimated 60 Billion dollars per year in medicare fraud. This article just represents company/organizational fraud....there are billions committed by individuals. The govt. says it's difficult to chase individual fraud so they typically don't.....However, if they didn't allow it upfront at the time of application for assignment of Medicare benefits...they'd save alot of time and money. I've written multiple times to the Whitehouse inquiring about this. They have hired 20,000 individuals for the IRS when the new healthcare plan is instituted re: to collect tax fees, but, they can't assign more employees to address this??

Deborah M.
Deborah M.4 years ago

Many people I know do not even look at the paperwork telling them what has been covered on their medicare claim. I guess one of the preventing fraud tips should have been OPEN the envelope and READ it!!!