Do You Know How to Spot Medicare Fraud


by Mary Jane Stern

Protecting yourself from Medicare fraud is the first thing you need to do.  But learning how to identify or spot fraud is equally important.

During 2009 the Department of Justice recovered nearly a billion dollars in health care fraud.  Plus they recorded 300 convictions.  Look at what they are currently pursing and this is only during the month of April 2010.  You can read the full reports at

  • Maine - April 16, 2010 - Rockland Woman Sentenced on Federal Health Care Fraud and Drug Charges
  • Georgia - April 16, 2010 - Rome Couple Charged with $30 Million Medicare & Medicaid Fraud Through Failure of Care at Three Nursing Homes
  • California - April 15, 2010 - Orange County Cancer Doctor Charged with Defrauding Medicare and Other Health Insurers in $1 Million
  • Maryland - April 15, 2010 - Maryland Woman Indicted by Federal Grand Jury for D.C. Medicaid Fraud
  • Michigan - April 15, 2010 - Detroit Area Patient Recruiter Sentenced to 27 Months in Prison for Medicare Fraud Scheme
  • New York - April 13, 2010 - Former Program Director of Medicaid-Funded Nonprofit Pleads Guilty in Manhattan Federal Court to Stealing Nearly a Million Dollars
  • Texas - April 13, 2010 - Medical Supplier Sentenced To Federal Prison for Motorized Wheelchair Scam
  • California - April 12, 2010 - Los Angeles Business Owner Pleads Guilty to Submitting Nearly Half a Million Dollars in False and Fraudulent Claims to Medicare
  • Florida - April 12, 2010 - Miami Man Pleads Guilty To $61 Million Medicare Fraud Scheme

Medicare has put together some great information to help you spot/identify fraud:

Be suspicious of doctors, health care providers, or suppliers that tell you the following:

  • The equipment or service is free; it won’t cost you anything, and they only need your Medicare number for their records.
  • Medicare wants you to have the item or service.
  • They know how to get Medicare to pay for the item or service.
  • The more tests they provide, the cheaper the tests become.

Be suspicious of doctors or plans that do the following:

  • Don’t charge copayments without checking on your ability to pay.
  • Advertise “free” consultations to people with Medicare.
  • Claim they represent Medicare or a branch of the Federal government.
  • Use pressure or scare tactics to sell you high-priced medical services or diagnostic tests.
  • Bill Medicare for services you didn’t get.
  • Use telephone calls and door-to-door selling as marketing tools.
  • Offer non-medical transportation or housekeeping as Medicare‑approved services.
  • Put the wrong diagnosis on the claim so that Medicare will pay.
  • Bill home health services for patients who aren’t confined to their home, or for Medicare patients who still drive a car.
  • Bill Medicare for medical equipment for people in nursing homes.
  • Ask you to contact your doctor and ask for a service or supplies that you don’t need.
  • Bill Medicare for tests you received as a hospital inpatient or within 72 hours of admission or discharge.
  • Bill Medicare for a power wheelchair or scooter when you don’t meet Medicare’s qualifications.

Watch Out For These Common Fraud Schemes:

  • People who approach you in parking lots, shopping centers, or other public areas and offer free services, groceries, transportation, or other items in exchange for your Medicare number. Just walk away!
  • People who call you claiming to be conducting a health survey and ask for your Medicare number. Simply hang up the phone!
  • Telephone marketers who pretend to be from Medicare or Social Security and ask for payment over the phone or Internet. Don’t do it! They may want to steal your money.

What happens if you suspect Medicare fraud?  You are encouraged to report the fraud.  You can report it to:

The Office of Inspector General

Call: 1-800-HHS-TIPS (1-800-447-8477) TTY: 1-800-377-4950


1 Response

  1. I was told by a major Insurance IT exec that when they process claims for medicare, they do not run fraud softwaree like they do on their own claims.

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