Medicare fraud costs the federal government an estimated $60 billion or more each year. Protecting the Medicare program from fraud, abuse, and waste is a shared responsibility. Beneficiaries who review their Medicare Summary Notices and report suspicious activity play an important role in keeping the program financially sound.
What Is Medicare Fraud, Abuse, and Waste?
| Term | Definition | Example |
|---|---|---|
Fraud | Intentional deception to receive unauthorized payment | Billing for services never provided; using a stolen Medicare number |
Abuse | Practices inconsistent with sound medical or fiscal standards | Billing for services that are not medically necessary |
Waste | Overutilization of services without intentional deception | Ordering excessive lab tests without clinical justification |
Common Examples of Medicare Fraud
Common Medicare fraud schemes include billing for services that were never provided, upcoding (billing for a more expensive service than was actually performed), billing for unnecessary services, using someone else's Medicare number, paying or receiving kickbacks for patient referrals, and offering free medical equipment in exchange for a Medicare number.
How to Report Medicare Fraud
| Method | Contact |
|---|---|
Call Medicare directly | 1-800-MEDICARE (1-800-633-4227), available 24/7. TTY: 1-877-486-2048 |
Office of Inspector General (OIG) | 1-800-HHS-TIPS (1-800-447-8477) or online at oig.hhs.gov |
Senior Medicare Patrol (SMP) | Find your local SMP at smpresource.org - free counseling and fraud reporting help |
Your Medicare Advantage or Part D plan | Contact your plan directly if the fraud involves a private plan |
Review Your Medicare Summary Notice Regularly
Your Medicare Summary Notice (MSN) lists all services billed to Medicare on your behalf. Review it carefully every time you receive one. If you see a charge for a service you did not receive, or a date when you were not seen by that provider, report it immediately.
How to Protect Yourself from Medicare Fraud
Protect your Medicare number like a credit card number. Never share it with anyone who contacts you unsolicited by phone, email, or door-to-door. Be wary of free offers in exchange for your Medicare number, pressure to sign up for services you do not need, and anyone claiming to be from Medicare who asks for your personal information over the phone. Medicare will never call you to sell you anything.
Whistleblower Rewards
If you report fraud that leads to a government recovery, you may be eligible for a financial reward under the False Claims Act. Whistleblowers who report Medicare fraud through a qui tam lawsuit can receive 15% to 30% of the government's recovery. An attorney specializing in False Claims Act cases can advise you on whether your situation qualifies.
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