Most Medicare payment errors are simple mistakes
and are not the result of physicians, providers, or suppliers trying
to take advantage of the Medicare system. If you have a question or
concern regarding a Medicare claim submitted on your behalf, you should
discuss it directly with your physician, provider, or supplier that
provided the service.
majority of physicians, providers, and suppliers who serve people
with Medicare are committed to providing high quality care to their
patients and to billing the program only for the payments they have
earned. Few sources accept medicare wheelchairs, so for mobility
scooters and wheelchairs
there are a few individuals who are intent on abusing or defrauding
Medicare, cheating the program (and in some cases the people with
Medicare who are liable for co-payments) out of millions of dollars
annually. Medicare fraud takes a lot of money every year from the
Medicare program. People with Medicare pay for it with higher premiums.
This section of the website is dedicated to helping you to help
Medicare to avoid making inappropriate payments to fraudulent entities.
is taking strong action to combat fraud and abuse of the system
in key areas. Our goal is to make sure Medicare only does business
with physicians, providers, and suppliers who will provide people
with Medicare with high quality services.
to prevent and detect fraud is a cooperative one that involves:
for Medicare & Medicaid Services (CMS)
People with Medicare
Providers of Medicare services including physicians, providers,
State and Federal Agencies such as, the Department of Health and
Human Services Office of the Inspector General, the Federal Bureau
of Investigation (FBI), and the Department of Justice.
What is Fraud?
fraud is purposely billing Medicare for services that were never
provided or received.
examples of Medicare fraud include:
Medicare or another insurer for services or items you never got.
Billing Medicare for services or equipment which are different from
what you got.
Use of another persons Medicare card to get medical care,
supplies, or equipment.
Billing Medicare for home medical equipment after it has been returned.
should be suspicious if the provider tells you that:
is free; he only needs your Medicare number for his records. NOTE:
For clinical laboratory tests, there is no co-payment and a provider
may in good faith state that the test is free, since there is not
cost to the person with Medicare.
Medicare wants you to have the item or service.
They know how to get Medicare to pay for it.
The more tests they provide the cheaper they are.
The equipment or service is free; it won't cost you anything.
Be suspicious of providers that:
co-payments on clinical laboratory tests, and on Medicare covered
preventive services such as PAP smears, prostate specific antigen
(PSA) tests, or flu and pneumonia shots.
Routinely waive co-payments on any services, other than those previously
mentioned, without checking your ability to pay.
Advertise "free" consultations to People with Medicare.
Claim they represent Medicare.
Use pressure or scare tactics to sell you high priced medical services
or diagnostic tests.
Bill Medicare for services you did not receive.
Use telemarketing and door-to-door selling as marketing tools.
prevent Medicare fraud, you should report suspected instances of
fraud. Whenever you receive a payment notice from Medicare, review
it for errors. The payment notice shows what Medicare was billed
for, what Medicare paid and what you owe. Make sure Medicare was
not billed for health care services or medical supplies and equipment
you did not receive.
following is a list of tips to prevent fraud:
ever give out your Medicare Health Insurance Claim Number (on your
Medicare card) except to your physician or other Medicare provider.
Don't allow anyone, except appropriate medical professionals, to
review your medical records or recommend services.
Don't contact your physician to request a service that you do not
Do be careful in accepting Medicare services that are represented
as being free.
Do be cautious when you are offered free testing or screening in
exchange for your Medicare card number.
Do be cautious of any provider who maintains they have been endorsed
by the Federal government or by Medicare.
Do avoid a provider of health care 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.
It is in your best interest and that of all citizens to report suspected
fraud. Health care fraud, whether against Medicare or private insurers,
increases everyone's health care costs, much the same as shoplifting
increases the costs of the food we eat and the clothes we wear.
If we are to maintain and sustain our current health care system,
we must work together to reduce costs.
to previous information concerning ambulance services:
In a previous fraud flyer intended to assist beneficiaries in recognizing
fraudulent practices in the Medicare program, we advised beneficiaries
to be suspicious of ambulance companies that bill for trips that
are not emergency in nature. That statement is misleading. Non-emergency
ambulance services are covered by the Medicare program when reasonable
and necessary. We apologize for any misunderstandings or confusion
that may have resulted from this statement.
How to Report Medicare Fraud
You, as the Medicare beneficiary, are the most important link in
finding Medicare fraud. You know better than anyone what healthcare
services you have received. Review your Medicare Summary Notice
when you receive it, and make sure you understand all of the items
dont remember a procedure that is listed, you should first
call your physician, provider, or supplier that is listed on the
Medicare Summary Notice. Many times a simple mistake has been made
and can be corrected by your physician, provider, or suppliers
office when you call.
physician, provider, or suppliers office does not help you
with the questions or concerns about items listed on your Medicare
Summary Notice and you still suspect Medicare fraud or if you cannot
call them, you should call or write the Medicare company that paid
the claim. The name, address, and telephone number are on the Medicare
Summary Notice (MSN) you receive, which shows what Medicare paid.
contacting the Medicare claims processing company, carefully review
the facts as you know them and as shown on the Medicare Summary
Notice. Write down:
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.
If you plan to write rather than call, clearly state at the beginning
of your letter that you are filing a fraud complaint. This will
help to ensure that your complaint is forwarded to the fraud unit.
of Inspector General Hotline
assist you, the Office of the Inspector General maintains a hotline,
which offers a confidential means for reporting vital information.
The Hotline can be contacted:
By Fax: 1-800-223-8164
By E-Mail: HTips@os.dhhs.gov
By TTY: 1-800-377-4950
By Mail: Office of Inspector General
Department of Health and Human Services
330 Independence Ave., SW
Washington, DC 20201
For more information visit Medicare