What is Medicare Fraud?
The majority of all
Medicare payment mistakes are simply that - mistakes, a natural part of human
error. When these mistakes occur, they
usually are not the result of providers, doctors or suppliers looking to take
advantage of the system. In most cases,
these issues can be easily resolved by directly contacting the entity who
provided you with a particular service.
For the most part,
providers, doctors and suppliers who tend to the needs of Medicare recipients
do so with genuine purpose. These people
are committed to the cause, which is providing quality care to patients and making
sure they are billed accurately. On the
other hand, you have a few malicious individuals that are intent on either
abusing or defrauding the Medicare system.
Collectively, these people cheat the program for millions of dollars on
an annual basis. This means that
millions of dollars are taken away from the program, cheating those who are in
dire need of medical assistance.
Medicare fraud results in higher premium rates for innocent people who
may not be effected directly, but end up suffering nevertheless.
Making a Report
While providers, doctors
and suppliers play a huge part in the process, as a Medicare beneficiary, you
are the most essential link to detecting fraud.
Just think about it - you know better than anyone else if you did or did
not receive healthcare services. Upon
receiving your Medicare Summary Notice, thoroughly review it to ensure that you
understand all of the items and charges listed.
If a questionable procedure is listed, do not hesitate to contact your
provider, doctor or supplier listed on the document. Many times this is simply an error than can
be rectified by phone.
In the event that your
provider, doctor or supplier can't help to resolve an issue and you suspect
Medicare fraud, immediately write the entity that paid the claim. Information such as a name, address and
telephone number should be easy to find on your Medicare Summary Notice.
Before contacting the
company that processes your Medicare claims, be sure to review the facts as you
know them and as they are displayed on the Medicare Summary Notice. It is very important to take note of the
following:
• the provider's name and your account
or identifying number
• the fee or service in question
• the date on which the service is said
to have occurred
• the amount approved and paid by your
Medicare provider
• the date on your Medicare Summary
Notice
• the reason you are disputing the
claim
• any
other information that proves the claim for service should have not been
processed and paid by Medicare
If you are
more comfortable writing instead of calling, be sure to clearly state in the
letter that you are filing a fraud complaint.
This gives you more assurance that the complaint will be forwarded
accordingly to the fraud unit.
Below is
the information you need to contact the United States HHS (Human and Health
Services):
By
Phone:
(800)
HHS-TIPS (1-800-447-8477)
By Mail:
Office of
the Inspector General
HHS TIPS
Hotline
P.O. Box
23489
Washington,
DC 20026
