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How to avoid medicare fraud and abuse

Learning Center > Medicare Resources > How to avoid medicare fraud and abuse

Medicare Fraud:

Medicare fraud costs taxpayers lots of money every year and drives up taxes and healthcare costs for all Americans.  Fraud can occur by someone stealing your Medicare number or by a medical professional billing for services not rendered.

What is Medicare Fraud? Medicare fraud is defined as “In the United States, Medicare fraud is the claiming of Medicare health care reimbursement to which the claimant is not entitled. There are many different types of Medicare fraud, all of which have the same goal: to collect money from the Medicare program illegitimately.[1]

Types of Medicare Fraud:

  1. Billing for medical services that are not necessary, or that didn’t happen. Could also be for equipment that was never used or equipment that was said to be new but had been used before.
  2. Stealing someone’s identity to obtain medical services.
  3. Excessively high charges for upcoding for services provided.
  4. Kickbacks in exchange for providing Medicare information for services that didn’t happen.

How to protect yourself.:

Recognize that until your new Medicare card arrives, your social security number is typically your Medicare Claim number. The new card will not contain this information. You should protect your Medicare number like you would with any personal information. If you don’t need to carry your Medicare card in your wallet, leave it somewhere safe.

New Medicare cards are being sent out starting in April 2018 – April 2019.

Review your Medicare explanation of benefits, for fraudulent charges. Contact 1-800-Medicare or the Office of the Inspector General at 1-800-447-8477. In some occasions there is a reward for reporting Medicare Fraud.

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