Medicare: The fight against fraud

Each year criminals steal billions of dollars from Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). So what is the federal government doing to stop it?

According to a recent press release from CMS (the Centers for Medicare & Medicaid Services), the government is becoming more proactive about keeping criminals out of federal healthcare programs in the first place.

Medicare  has adopted a more rigorous screening process for new providers and suppliers. This is intended to weed out crooks before they can start submitting fraudulent bills to the government.

As a result of the Affordable Care Act, Medicare now uses sophisticated technologies and innovative data sources to identify patterns associated with fraud. And when there’s a credible allegation of fraud against a provider or supplier, Medicare can temporarily stop payments to them while an investigation is undertaken.

“In other words, Medicare is moving away from the old “pay and chase” model of doing business – paying out claims and then trying to recover the fraudulent ones”, according to David Sayen, Medicare’s regional administrator for California, Arizona, Nevada, Hawaii, and the Pacific Trust Territories.

In 2010 the federal government recovered $4 billion from people who attempted to defraud seniors and Medicare. That’s a record amount and a good sign that the fight against fraud is working.

Mr. Sayen’s recent press release offered suggestions on how Medicare beneficiaries can help in the fight against healthcare fraud:

  • Guard your Medicare and Social Security numbers. Treat them like you treat your credit cards. Criminals use these numbers to send the government bogus medical bills — in your name.
  • Hang up the phone if someone calls and asks for your Medicare number, Social Security number, or bank or credit card information. Medicare will NEVER call and ask for this information, and we will NEVER call you or come to your home uninvited to sell Medicare products.
  • Be suspicious of anyone who offers you free medical equipment or services and then requests your Medicare number. It’s illegal, and it’s not worth it!
  • Don’t let anyone borrow or pay you to use your Medicare ID card or your identity.
  • Check your Medicare claims for errors. Look at your Medicare Summary Notice or statements from your Medicare plan.
  • If your Medicare Summary Notice shows billings for goods or services that you never received, call us at 1-800-MEDICARE (1-800-633-4227). The sooner you see and report suspected fraud, the sooner we can stop it. TTY users should call 1-877-486-2048.

What Next?

Related Articles

Leave a Reply

Submit Comment