How To Report Medicare Fraud

by Mary Jane Stern

Do you suspect Medicare fraud?  Are you reluctant to report it?  Reporting any type of fraud helps protect yourself, Medicare and millions of others who might be a potential victim.

Every Medicare beneficiary receives a payment notice from Medicare. It’s called the Medicare Summary Notice (MSN).  Take a few minutes to review it for errors.  When you see items on the notice that you question, highlight them.  Here’s what to look for:

• Was Medicare billed correctly for services you were provided? (For example, if you had an appointment on June 1 with your doctor and your next appointment was scheduled for September 1, there should only be one charge, not two or three additional office visit charges.)
• Are there any medical services, supplies or equipment you didn’t get, but have been billed?

Did you see any questionable items?  If yes, then your next step would be to contact the healthcare provider or supplier with your questions or concerns regarding the issues you found on your Medicare Summary Notice.

Seems easy enough, right? But, the provider or supplier doesn’t want to help you; you can’t seem to reach them; perhaps the phone number was disconnected.  What do you do? It’s discouraging to think someone could do this, but don’t get discouraged, be proactive.  How?

It’s time to report the errors to Medicare and here’s what Medicare suggest you do:

• Call 1-800-MEDICARE.
• Write a letter to Medicare. Mail it to: Beneficiary Contact Center, PO Box 39, Lawrence KS, 66044.
• Call the HHS Office of Inspector General Hotline at 1-800-HHS-TIPS (1-800-447-8477). TTY users should call 1-800-377-4950.
• Send an e-mail to the HHS Office of Inspector General at hhstips@oig.hhs.gov.
• Write a letter to the Department of Health and Human Services. Mail it to: HHS Tips Hotline, PO Box 23489, Washington, DC 20026‑3489.

Medicare is very discrete and they will not use your name if you ask them not to use it.

Please, before you call anyone, take time and review all the facts carefully.  Here’s the information Medicare or the Inspector General will require:

• The provider’s name and any identifying number you may have
• The service or item you are questioning
• The date the service or item was supposedly given or delivered
• The payment amount approved and paid by Medicare
• The date on your Medicare Summary Notice
• Your name and Medicare number (as listed on your Medicare card)
• The reason you think Medicare shouldn’t have paid
• Any other information you have showing why Medicare shouldn’t have paid for a service or item

You might be entitled to a reward of up to $1,000 if the suspicious activity you are reporting turns out to be Medicare fraud.  However, there are a few conditions that need to be met:

• You report your suspicion
• Your suspicion is referred to the Inspector General’s office for review
• The fraud you report isn’t already being investigated
• Your report leads directly to the recovery of at least $100 of Medicare money
• You are not related to people who work for certain federal agencies

If you want to know more about the Medicare fraud reward program, call 1‑800‑MEDICARE (1-800-633-4227). TTY users should call 1‑877‑486‑2048.