Medicare
fraud and abuse can happen anywhere. It’s important that you protect your Medicare number and other personal information, and check your Medicare claims regularly so you don’t become a victim. What are some examples of Medicare fraud?
To help spot and prevent Medicare fraud and abuse:
- Compare the dates and services on your calendar with the Medicare statements you get to make sure you got each service listed and that all the details are correct.
- Know what a Medicare health or drug plan can and can’t do before you join.
- Learn more about Medicare and recent scams.
If you suspect fraud call 1-800-MEDICARE (1-800-633-4227) or online:
If you have a Medicare Advantage Plan or Medicare drug plan you can also call the Investigations Medicare Drug Integrity Contractor (I-MEDIC) at 1-877-7SAFERX (1-877-772-3379). What information should I have ready when I call?
Medicare Fraud and Abuse: A Serious Problem That Needs Your Attention
Although no precise measure of health care fraud exists, those who exploit Federal health care programs can cost taxpayers billions of dollars while putting beneficiaries’ health and welfare at risk. The impact of these losses and risks magnifies as Medicare continues to serve a growing number of beneficiaries.
Most physicians try to work ethically, provide high-quality patient medical care, and submit proper claims. Trust is core to the physician-patient relationship. Medicare also places enormous trust in physicians. Medicare and other Federal health care programs rely on physicians’ medical judgment to treat patients with appropriate, medically necessary services, and to submit accurate claims for Medicare-covered health care items and services.
You play a vital role in protecting the integrity of the Medicare Program. To combat fraud and abuse, you must know how to protect your organization from engaging in abusive practices and violations of civil or criminal laws. This booklet provides the following tools to help protect the Medicare Program, your patients, and yourself:
Medicare fraud and abuse examples
Overview of fraud and abuse laws
Government agencies and partnerships dedicated to preventing, detecting, and fighting fraud and abuse
Resources for reporting suspected fraud and abuse
Health care professionals who exploit Federal health care programs for illegal, personal, or corporate gain create the need for laws that combat fraud and abuse and ensure appropriate, quality medical care.
Physicians frequently encounter the following types of business relationships that may raise fraud and abuse concerns:
● Relationships with payers
● Relationships with fellow physicians and other providers
● Relationships with vendors
These key relationships and other issues addressed in this booklet apply to all physicians, regardless of specialty or practice setting.
Source: U.S. Centers of Medicare & Medicaid Services. “Medicare Fraud and Abuse: Prevent, Detect, Report, MLN Booklet.” 1/21/2024
