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 everyone 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.

Here are some tips, provided by Medicare.

What Is Medicare Fraud?

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
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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

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

How to Prevent Medicare 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

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

Report suspected fraud to the Inspector General by calling 1-800-447-8477 or emailing [email protected].

For more information on preventing Medicare fraud, visit the Stop Medicare Fraud website