Each year, the Medicare program loses billions of dollars to claims that are fraudulent. These claims can include providers billing Medicare for services or equipment that were never received by patients, as well as individuals using another person’s Medicare ID number in order to illegally obtain care.
Because of this Medicare fraud, health care costs become higher for everyone – including individuals, businesses, and even the federal government. But there are ways to detect and to stop fraud, which can in turn help to lower these overall costs – and in some cases, helping to fight Medicare fraud could even pay off for those who report it.
There are many ways in which the Medicare program is defrauded out of benefit dollars each year. Some of the more popular scams include:
Because the program is so large and funded by the U.S. government, the pockets of Medicare run deep. Therefore, it can attract some very organized crime groups who can essentially receive large payoffs and profits.
Yet another incentive for these criminals is that – even if caught – the scammers will oftentimes receive a much lighter sentence than those who are caught doing other crimes such as drug trafficking – yet Medicare fraud can have a much bigger payoff for those who don’t get caught.
Although it may appear difficult to detect, there are ways that consumers can help in detecting Medicare fraud. For example, certain “red flags” may be present if a medical provider states any of the following to you regarding your health care equipment or services:
In addition, you may also be dealing with a provider that is committing Medicare fraud if they are engaging in any of the following:
If you have been a victim of Medicare fraud, or even if you suspect that a fraudulent Medicare-related incident has taken place, there are several ways in which you can report it. One way is to call Medicare directly, toll-free, at 1-800-633-4227.
Alternatively, you can contact the Office of the Inspector General, at 1-800-447-8477, or you can go online to the Office of Inspector the General website, where you will find a Report Fraud Form by clicking here.
Prior to contacting either of these entities to report Medicare fraud, it is recommended that you have the following information on hand:
You will also be asked to provide your name and Medicare number, as well as the reason(s) why you feel that the incident is fraudulent.
Because Medicare fraud costs the U.S. government millions of dollars every year, those who report fraudulent incidents may be eligible for a reward of up to $1,000, provided that all of the following criteria are met:
Putting a stop to Medicare fraud can require joint cooperation from many different entities, including individuals, health care providers, insurance companies, law enforcement, and even the U.S. government.
There are several programs that have been put into place that contain measures on stopping Medicare fraud. These include:
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Author Bio: Ben started Prepare for Medicare in 2014 to help people help people get objective answers to questions about Medicare. He’s held leadership roles at numerous Fortune 500 Medicare health insurers in product development, sales, marketing and strategy for over 20 years.