Choice Insurance Agent

The Medicare system is vulnerable to attacks from fraudsters because it operates using the “honor system” of claims submission. Most doctors, healthcare providers, suppliers, and private companies are trustworthy. Unfortunately, this is not the case. At the same time, the system itself has few mechanisms to detect fraudulent claims, being that it focuses more on paying claims quickly and smoothly.

The government loses roughly around sixty billion dollars per annum from these fraudulent activities targeted at the Medicare program, which makes it one of, or the most profitable illegal venture in the US today. As an American taxpayer, you are the one being ripped off, and sometimes, this happens without you knowing it. Fraud and abuse take critical resources out of our health care system, and contribute to the rising cost of medical care for all Americans. This underscores the importance of prompt and proper Medicare fraud reporting.

Medicare fraud reporting

If upon inspection of your Medicare summary notice, you came across healthcare services that were not performed or products and equipment that you did not receive, you have to contact the providers listed on the document to inform there of the error and have those rectified. If you cannot contact them, or your queries are being ignored, or they refuse to assist you, consider calling the Medicare fraud hotline at 1-800-MEDICARE or 1-800-633-4227. Those who are using TTY devices may contact 1-877-486-2048. The Office of the Inspector General also retains a Medicare fraud hotline, which provides you a discreet way of exposing fraudulent activities of healthcare providers and suppliers. The hotline can be reached via phone, fax, snail mail, or e-mail. Residents of Florida may contact their State’s Medicare fraud hotline which handles cases from this jurisdiction only.

What a lot of people do not know is that there is a statute which allows citizens to sue a person or company who is knowingly submitting false bills to the federal agencies, including Medicare. This “qui tam” provisions can be found under the US Civil False Claims Act. The said legislation also provides protection to qui tam plaintiffs against demotion, suspension, discrimination or any form of harassment in terms of employment.

Whistleblowers are entitled to 15-30% of the government’s total recovery. To recover this bounty, the complainant should comply with complex statutory requirements. Just providing information to a hotline will not entitle them to the reward mentioned in this law.

Medicare fraud hotline is important because the government loses 60 billion dollars annually from this criminal activity. You can find the Medicare fraud hotline and overview of the reporting procedure here.

The Medicare system is the healthcare insurance plan provided by the government for Americans age 65 and over. This provides coverage for healthcare costs like check-ups, hospital stays, meds, equipment, and procedures. Unfortunately, the system is milked by fraudulent individuals who are taking advantage of the lack of mechanisms that validate the veracity of claims.

There are various tactics employed to carry out Medicare fraud, and phantom billing is an example. In this scheme the healthcare provider bills Medicare for procedures and tests that were never performed or a supplier that bills for durable medical equipment that were never used or delivered. Tactics like upcoding and unbundling are also quite prevalent. Upcoding involves inflating bills by using diagnosis or procedure billing code to justify why the patient needs expensive treatments or tests.

Unbundling is the practice of breaking down services like blood and chemistry panels into individual components, resulting in a higher payment by Medicare. Identity theft is also a known Medicare fraud tactic which occurs when someone steals your personal information, in this case your Medicare information, to obtain medical care, buy drugs, or submit fake billings using your name.

Fraud costs the Medicare program millions of dollars annually, and you end up paying for this with higher health care costs. This underlines our responsibility to report Medicare fraud. To spot Medicare fraud, you have to make it a habit to record the dates and save receipts and statements you get from providers every time you get healthcare services. Compare these against your Medicare summary notice and check for entries that are erroneous. If you find any billing errors, call the provider or supplier first, so they will be notified about it and make necessary corrections. However, if they do not return your calls, or refuses to help you correct those errors; don’t hesitate to contact the Medicare hotline at 1-800-MEDICARE. The sooner you see and report these fraudulent activities, the sooner Medicare can stop it.

Also, protect your Medicare number. Be leery of people who offer you free medical equipment or services and then requests your Medicare number. Remember, if it’s free, why do they need your number? Lastly, do not lend your Medicare ID to anyone or offer it for rent.

Medicare fraud is rampant and it milks billions of dollars from our health care system. Click here to know where to report Medicare fraud. Click here for more information on report medicare fraud