FRAUD

Most doctors, health care providers, suppliers, and private companies who work with Medicare are honest. However, there are a few who aren’t. Medicare is trying harder than ever to find and prevent fraud and abuse by working more closely with health care providers and strengthening oversight. There is also a joint effort between the Department of Health and Human Services and the Department of Justice to launch an enforcement team to review claims and investigate providers for possible Medicare fraud.
Fraud costs the Medicare Program millions of dollars every year. You pay for fraud with higher health care costs. Fraud schemes may be carried out by individuals, companies, or groups of individuals.
The following are examples of possible Medicare fraud:
A health care provider bills Medicare for services you never got.
A supplier bills Medicare for equipment you never got.
Someone uses another person’s Medicare card to get medical care,supplies, or equipment.
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.
In addition to watching for Medicare fraud, you should also protect yourself from identity theft. Identity theft happens when an individual uses your personal information (like your name, Medicare number, credit card number, or Social Security number) without your consent to commit fraud or other crimes. See page 9 for more information on how to protect yourself from identity theft.