Medicare fraud reporting has not been common in the United States nowadays despite many frauds. Medicare fraud is characterized by instances wherein a medical provider tries to cheat the Medicare program through false information for monetary gain.
Some accusations towards providers didn’t have sufficient supporting evidence, thus many frauds go undetected. Many providers, suppliers and physicians take advantage of the “honor system” of billing followed by the Medicare program. In the past, it was meant to assist honest physicians who care for the less fortunate with medical services.
The following types of circumstances necessitate Medicare fraud reporting:
1. Patient Billing – this happens when the patient who also takes part in the fraud will present their Medicare number in order to get kickbacks. The physician, supplier or provider will charge Medicare and the patient will pretend to have received the medical service or item.
2. The provider inflates the bills through a billing code falsely stating that the patient needs to go through an expensive medical procedure.
3. Phantom Billing – this is a scenario wherein the medical supplier, provider or doctor will charge Medicare for excessive services or for services that were never provided for, such as medical tests or equipment. To prevent this, the patient can closely examine the records for any discrepancy.
As a beneficiary of Medicare, the program relies on you as a vital link to detecting Medicare fraud. Only you can really narrow down the services and items that were and were not provided to you. Once you’ve received your Medicare Summary Notice, it is best to thoroughly examine its contents.
If you find anything suspicious, notify the physician, supplier or provider as it might just be an honest mistake. If they do not assist you about it, then you can report them.
The Medicare Fraud hotline is 1-800-HHS-TIPS (1-800-447-8477). You can also contact them by Fax at 1-800-223-2164 (maximum of 10 pages), and email at HHSTips@oig.hhs.gov.