Tips for Avoiding Medicard Fraud and Abuse

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.

One Response to Tips for Avoiding Medicard Fraud and Abuse

  • Alberto Gonzalez says:

    Hello, my dad who lives in Florida has medicare as well as medicaid. He lives in south Florida and almost all of the things that have been pointed out in this article about fraud happens down there just about on a constant basis. My dad is 82 and at this point I believe that he does not know any better. I handle just about all of things that have to do with his health. I personally know that he has friends that were offered 200 dollars just to join an HMO in the area. I can give you more examples but I don`t want to get into it at this time. The point of me writing this is to help catch and hopefully convict some of these people who are committing these acts.

Leave a Reply

Your email address will not be published. Required fields are marked *



Search Now!

Free Medicare Guide!