Medicare fraud and abuse costs everyone and costs Medicare billions of dollars every year. It can cost you higher Medicare premiums, deductibles, and copayments. You may pay for items or services you never receive. It can hurt you if you get tests, medication, or treatments you don’t need. And Medicare losing money means there’s less funding for improving Medicare coverage for everyone.
What is Medicare Fraud?
Medicare fraud is intentionally billing Medicare for services that were never provided. For example, your Medicare number can be used to bill Medicare for services and supplies you didn’t need or want, services and supplies your doctor did not order, services and supplies you can’t even use, and services and supplies you did not receive.
Some other common examples of fraud and abuse include:
Providing unsolicited supplies to beneficiaries and then charging Medicare
Misrepresenting a diagnosis, a beneficiary’s identity, the service provided, or other facts to justify payment
Prescribing or providing excessive or unnecessary tests and services
Violating the participating provider agreement with Medicare by refusing to bill Medicare for covered services or items and billing the beneficiary instead
Offering or receiving a kickback (bribe) in exchange for a beneficiary’s Medicare number
Requesting Medicare numbers at an educational presentation or in an unsolicited phone call
Routinely waiving co-insurance or deductibles. Waivers are only allowed on a case-by-case basis where there is a financial hardship, not as an incentive to attract business.
Learn about recent Medicare fraud schemes and tips to prevent and detect such scams. Available in up to 9 languages. Read more…
Looking for materials to educate others on Medicare fraud? Order Today!
Learn about current Medicare fraud schemes with a mix of humor and fun. Watch videos
Share short messages and tips on preventing and detecting various types of Medicare fraud. Go to PSAs
Harm to Beneficiaries
Medicare fraud and abuse not only harms the Medicare program and drains taxpayer dollars, it also directly harms beneficiaries. It can do this in three main ways: medical identity theft,harm to health, and personal financial losses.
Medical Identity Theft
Medical identity theft is when a provider, supplier, or someone else misuses your Medicare number. It can also be if a person pretends they are you and uses your card to get Medicare-covered services. This causes your number to be compromised and can lead to Medicare being charged for items and services you never received. It can also mean that for some services that Medicare has limits on, if your record shows your number was billed, you could be denied a service or item you need.
Harm to Health
Fraudulent providers can provide poor-quality care, false diagnoses, and/or unnecessary treatments and medications that can severely impact a person’s health. An example is falsely diagnosing a person with cancer and giving him/her unneeded chemotherapy or radiation treatments.
False diagnoses can also lead to incorrect medical records, negatively affecting the care other legitimate providers give. For example, they may unknowingly prescribe medications for a condition a person doesn’t have or make a treatment plan based on false lab results, etc.
Personal Financial Losses
Medicare fraud and abuse can mean higher out-of-pocket costs, such as copayments for healthcare services that you never received, were excessive, or were medically unnecessary. You could also find yourself stuck with bills for services that your providers should have billed Medicare for but instead billed you for the entire cost of that service.