Medicare fraud is the act of physicians, providers or suppliers who willingly bill Medicare for services, procedures or equipment that were never provided or received. It is possible for medical services to be mistakenly billed to Medicare in error; however, in cases of Medicare fraud, this is not the case. The intention to abuse or cheat the system can take millions of dollars from the Medicare program each year, which results in increases in healthcare costs or higher premiums for patients who pay for it. Fortunately, there are many steps that you can take to help detect fraud, report it and further prevent future fraudulent activities by a provider.http://www.medicare.gov/FraudAbuse/Overview.asp If you are a patient who receives Medicare or you know somebody who does and feels a physician or provider may be taking advantage of the Medicare system, this page will show you how to report Medicare fraud.

When you receive your Medicare Summary Notice, you should take note of all of the procedures, services or equipment listed and check for errors. Services or procedures that are billed to Medicare although you never received them may indicate fraud. If you had equipment that was returned, yet it was still billed to Medicare after the fact, it can also be a cause for concern.

Aside from checking your MSN, you should also become aware of suspicious remarks or behaviors by your provider concerning the Medicare system. Here are a few things your provider may say or do, which should raise a red flag:

1. States that a test, service or equipment is free or they offer free consultations. Keep in mind that clinical laboratory tests do not require a co-payment and there is no cost to the person who is receiving Medicare. However, you should become concerned if you provider asks for your Medicare number anyways despite any “free” services.http://www.medicare.gov/FraudAbuse/Tips.asp/ref
2. Insists that Medicare wants you to have the item or service or they know how to get Medicare to pay for it.<ref>http://www.medicare.gov/FraudAbuse/Tips.asp
3. They mention that the more tests that are provided, the cheaper they are.http://www.medicare.gov/FraudAbuse/Tips.asp
4. Payments or gifts are offered to go to other offices or clinics.http://www.medicare.gov/FraudAbuse/Tips.asp
5. Co-payments are charged on clinical laboratory tests and on preventative services that are covered, such as flu vaccines and PAP smears.http://www.medicare.gov/FraudAbuse/Tips.asp
6. They claim they represent Medicare.http://www.medicare.gov/FraudAbuse/Tips.asp
7. Pressure and scare tactics are used to sell you high priced medical services or tests.http://www.medicare.gov/FraudAbuse/Tips.asp

If you feel as though there are errors made on your Medicare Summary Notice (MSN) or your provider’s behavior in regards to Medicare is fraudulent, you should report that matter to Medicare. In regards to errors on your MSN, you should direct any concerns to your provider or their office. In some cases, it could have been a minor mistake where a service was billed when it shouldn’t have and it can easily be corrected. If your provider or their office fails to assist you or you cannot reach them and you still suspect fraud, there are a number of steps you should take.

1. Contact (via phone or mail) the Medicare company that paid the claim. On your Medicare Summary Notice you will find the name, address and telephone number of whom you need to contact. When writing a letter, state in the beginning of the letter that you are filing a fraud complaint.http://www.medicare.gov/FraudAbuse/HowToReport.asp
2. Write down the following facts that can be found on your Notice – the provider’s name and identifying number, the service(s) you are concerned about and the date it was provided, the amount the service(s) was approved for and paid by Medicare, the date on the Medicare Summary Notice, the name and Medicare number of the person who received the service(s) and why you think Medicare should not have paid, as well as other information that will back up your suspicions.http://www.medicare.gov/FraudAbuse/HowToReport.asp

For further assistance, you can contact the Office of the Inspector General hotline. This is a confidential hotline to report fraud and you should be prepared to provide all of the information as stated above. The contact information for the hotline is 1-800-447-8477 (phone), 1-800-223-8164 (fax – no more than 10 pages), HHSTips@oig.hhs.gov (e-mail) or Office of the Inspector General, HHS TIPS Hotline, P.O. Box 23489, Washington, DC 20026 (mail).http://www.medicare.gov/FraudAbuse/HowToReport.asp

Medicare fraud is a serious situation; however there are numerous steps you can take to help prevent it from occurring or reoccurring. The first steps you should take are always reviewing your Medicare Summary Notice for errors and reporting anything you feel may be wrong or suspicious. You should also be cautious if you are ever offered free testing or services in exchange for your Medicare number or if you have a provider who states they are endorsed by Medicare or the Federal government. Never give out your Medicare Health Insurance Claim Number that is listed on your Medicare except to your provider when absolutely necessary. Do not allow anyone, except for authorized medical professionals review your medical or billing records or recommend services to you. Do not accept free services and do not ask your provider for services that you truly do not need. Also, as mentioned above, try to avoid any physicians who state they know how to get Medicare to cover a service or procedure that isn’t usually covered.http://www.medicare.gov/FraudAbuse/Tips.asp

Taking these preventative measures will help cut back on any fraudulent Medicare activity that is done by providers. By helping to stop any fraud, you will also be preventing future increases in healthcare costs due to the abuse of the Medicare system.