Report A Medicare Fraud
Friday, March 23rd, 2012Medicare 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.
How to spot scenarios that require Medicare fraud reporting:
1. When a patient plays a role in the fraudulency by providing his Medicare number to for kickbacks. The provider will bill Medicare with unused items and services for monetary gain.
2. Upcoding scheme and unbundling – this is when the bills are inflated with the use of a billing code that suggests the patient requires a costly 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.
Medicare needs the help of the beneficiary in tracking down the frauds. Beneficiaries have a direct contact to physicians, providers, and suppliers and can inform Medicare regarding discrepancies. 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.
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