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Reporting Medicare Fraud & Abuse


Reporting Medicare Fraud & Abuse

Medicare fraud and abuse can happen anywhere, and usually results in higher health care costs and taxes for everyone. Some examples include:

  • A provider that bills Medicare for services or supplies they never gave you, like charging you for a visit you never had, or a back brace you never got.
  • A provider that charges Medicare twice for a service or item that you only got once.
  • A person who steals your Medicare Number or card and uses it to submit fraudulent claims in your name.
  • A company that offers you a Medicare drug plan that Medicare hasn’t approved.

Alert: In January 2023, there was a privacy incident with a Medicare contractor that exposed the personal information of a small group of people with Medicare in Alabama, Georgia, and Tennessee. Letters were sent to everyone who might be impacted, with detailed information about what data was potentially exposed, and what to do next. If you didn’t get a letter, it’s very likely you weren’t impacted. If you want to confirm, you can call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.  Get more details and review the letter.

 

How to spot & prevent Medicare fraud & abuse

If you think you’ve spotted fraud, you may want to call your provider’s office to ask about it. They may be able to help you understand the charges, or figure out if they made a billing error.

If you suspect that Medicare is being charged for an item or service you didn’t get, or your Medicare card or number is stolen, use the contact information below to report suspected fraud or abuse.

If you experience:   Provider fraud or abuse in Original Medicare (including a fraudulent claim, or a claim from a provider you didn’t get care from)

If you experience:   Provider fraud or abuse in a Medicare Advantage Plan or a Medicare drug plan (including a fraudulent claim)

  • Contact:   1-800-MEDICARE (1-800-633-4227)
  • Or: The Investigations Medicare Drug Integrity Contractor
    (I-MEDIC) at 1-877-7SAFERX (1-877-772-3379), or by US mail:

Qlarant
28464 Marlboro Avenue
Easton, MD 21601
Attn: I-MEDIC

When you call, have this information ready:

  • Your name and Medicare Number.
  • The name of the provider that you’re reporting, along with any identifying information you may have.
  • The service or item you’re questioning and when you supposedly got it.
  • The amount that Medicare approved and paid.
  • The date on your Medicare Summary Notice, health or drug plan’s Explanation of Benefits, or claim.

 

Protecting yourself from identity theft  

Identity theft is a serious crime that happens when someone uses your personal information without your consent to commit Medicare fraud or other crimes. Use the following tips to protect yourself from becoming an identity theft victim.

Do:

  • Protect your Medicare Number and your Social Security Number.
  • Guard your Medicare card like it’s a credit card.
  • Become familiar with how Medicare uses your personal information. If you join a Medicare health or drug plan, the plan will let you know how it will use your personal information.
  • Remember that Medicare will never call you to sell you anything or visit you at your home. Medicare, or someone representing Medicare, will only call and ask for personal information in these 2 situations:
    1. A Medicare health or drug plan may call you if you’re already a member of the plan. The agent who helped you join can also call you.
    2. A customer service representative from 1-800-MEDICARE can call you if you’ve called and left a message or a representative said that someone would call you back.

Don’t:

Give your Medicare card, Medicare Number, Social Security card, or Social Security Number to anyone except your doctor or people you know should have it (like insurers acting on your behalf or people who work with Medicare, like your State Health Insurance Assistance Program (SHIP) A state program that gets money from the federal government to give free local health insurance counseling to people with Medicare.

  • Accept offers of money or gifts for free medical care.
  • Allow anyone, except your doctor or other Medicare providers, to review your medical records or recommend services
  • Join a Medicare health or drug plan over the phone unless you called us.

 

(Information courtesy of the Centers for Medicare and Medicaid Services, 2023)