Medicare Fraud and Abuse
You may be exposed to Medicare fraud at any time, before you enroll in a plan, when you access care at a doctor’s office or a facility or at other times. Learn about common behaviors and actions below that may help you recognize and protect yourself from fraudulent activity.
If you have Original Medicare, your doctor should not:
- Charge you for most preventive services
- Offer tests or other services that you do not need, especially if the doctor says that the more tests you receive, the cheaper they are
- Routinely waive you coinsurance (providers can waive cost-sharing for patients with great financial need, but not regularly)
- Medicare abuse includes practices that result in unnecessary costs to the Medicare program. Any activity that does not meet professionally recognized standards or provide patients with medically necessary services is considered abuse. Committing abuse is illegal and should be reported.
- Billing for unnecessary services (services that are not medically necessary). Overcharging for services or supplies.
- Misusing billing codes to increase reimbursement
There are several things you can do to help prevent Medicare fraud.
- Protect your Medicare number. Treat your Medicare card and number the same way you would a credit card number. Only give your Medicare number or your Social Security number to your doctors and other providers. Be careful when others ask for your Medicare number or offer free services if you provide your Medicare number.
- Protect your medical information. Be cautious if people other than your doctors or other medical professionals want to see your medical records or recommend services.
- Learn more about Medicare’s coverage rules. Be careful if a provider tells you there is a way to get Medicare to cover a service that normally is not covered.
- Do not accept services you do not need. If a provider is pressuring you into getting tests or other services you feel are unnecessary, turn down care or ask to get a second opinion from another physician.
- Be skeptical. It does not hurt to be wary if a provider says Medicare will pay for services that do not sound medically necessary (mud treatments, Swedish massages, and dance classes are examples of services promised in past fraud cases). Use your best judgment and refer to Medicare’s coverage rules as needed.
Always confirm that you received the services listed on either your Medicare Summary Notice (MSN) or your Explanation of Benefits (EOB). Sometimes this can be hard to do if you received services from several doctors at the same time. If you returned durable medical equipment (DME), your supplier should not continue to charge Medicare for rental fees or maintenance.
To report fraud, you should contact 1-800-MEDICARE (633-4227), the Senior Medicare Patrol (SMP) Resource Center (877-808-2468), or the Inspector General’s fraud hotline at 1-800-HHS-TIPS (447-8477). Medicare will not use your name while investigating if you do not want it to.