What is Fraud?
Most Medicare payment errors are simple billing mistakes and are not the result
of someone such as a physician, provider, or supplier trying to take advantage
of the Medicare Program. Fraud occurs when someone intentionally falsifies
information or deceives the Medicare Program. A common example of fraud is
purposely billing Medicare for services that were never provided or received.
complaint about the quality of care received from a doctor, other healthcare
provider, hospital, skilled nursing home facility, or home health agency is not
considered fraud. For more information if you have a complaint about your
quality of care, please
Most physicians, providers, and suppliers are committed to providing high-quality
care to their patients and to billing Medicare only for the services they have
provided. However, there are a few individuals who are intent on abusing or
defrauding Medicare by cheating the program. Medicare fraud takes a lot of money
from the Medicare Program.
You can help stop fraud by reviewing your Medicare statements to make sure
Medicare is not charged for items or services you did not receive.
Some examples of possible Medicare fraud are:
- A healthcare provider bills Medicare for services you never received.
- A supplier bills Medicare for equipment you never received.
- Someone uses another person’s Medicare card to get medical care, supplies, or
- Someone bills Medicare for home medical equipment after it has been returned.
- A company offers a Medicare drug plan that hasn’t been approved by Medicare.
- A company uses false information to mislead you into joining a Medicare plan.
What is Abuse?
Abuse occurs when doctors or suppliers do not follow good medical practices that
can result in unnecessary costs to Medicare. These practices may result in
unnecessary costs to the Medicare Program, improper payment, or services that
are not medically necessary.
Medicare is committed to protecting you and other people with Medicare from
fraud, abuse, and identity theft. Medicare is working very hard with other
government agencies to protect the Medicare Program.
When reporting suspected fraud, Medicare will not use your name if you do not
want them to. However, if you remain anonymous, it will be hard for Medicare and
other departments to conduct their investigation because they will have no way
to contact you.