Preventing Health Care Fraud

According to some estimates, 10 percent of the Medicare and Medicaid budget is blown by fraud. That's $50 billion of your tax dollars. What should you do if you think you were a victim of fraud? Here are some tips.

What constitutes health care fraud?

Medicare and Medicaid fraud is purposely billing the government for services that were never provided or received. Some examples of fraud include:

Billing Medicare, Medicaid or another insurer for services or items you never got.

Billing Medicare or Medicaid for services or equipment that are different from what you got.

Use of another person's Medicare or Medicaid card to get medical care, supplies, or equipment.

Billing Medicare or Medicaid for home medical equipment after it has been returned.

How do I report Medicare fraud?

The government's Medicare office advises that if you don't remember a procedure that is listed, you should first call your physician, provider or supplier that is listed on the Medicare Summary Notice. Many times a simple mistake has been made and can be corrected by your physician, provider, or supplier's office when you call.

The Office of the Inspector General maintains a hotline, which offers a confidential means for reporting information about fraud and other vital issues. The Hotline can be contacted by phone at 1800-HHS-TIPS or by e-mail at HHSTips@oig.hhs.gov.

How do I report Medicaid fraud?

The Medicaid Fraud Statutes Web Site contains a comprehensive listing of official state statutory citations that are used to prosecute civil or criminal fraud, or those used to maintain program integrity or to combat program abuse.

Click here to read more about how to report fraud.

How can I prevent health care fraud?

Whenever you receive a payment notice, review it for errors. For example, the payment notice shows what Medicare was billed for, what Medicare paid and what you owe. Make sure Medicare was not billed for health care services or medical supplies and equipment you did not receive.

Here are more ways to prevent fraud:

Don't ever give out your Health Insurance Claim Number (on your Medicare card), except to your physician or other Medicare or Medicaid provider.

Don't allow anyone, except appropriate medical professionals, to review your medical records or recommend services.

Be careful in accepting Medicare services that are represented as being free.

To learn more about Medicare and Medicaid:

• Find centers for Medicaid at Medicare service through the U.S. Department of Health and Human Services, click here.

• Click here for the official U.S. government website for Medicare.

• You can compare Medicare prescription drug plans here.

• Click here for a Medicare Coverage Database.

• You can get some helpful tips for navigating Medicare through the Medicare Rights Center.

• American College of Preventive Medicine's President-elect, Michael D. Parkinson, MD, MPH writes about consumer-driven health care here.