FYI
Medicare Fraud Costs Nation Billions a Year
Nearly 800 million claims for benefits were submitted to Medicare for payment in 1992. Some were fraudulent, some providers were warned, some were fined, some were thrown out to the Medicare Program, and some were sent to prison. Despite the efforts, it is estimated that as much as $ 10 billion was stolen from Medicare that year.
Each time Medicare pays a claim it shouldn't, the government is being ripped off, and as a taxpayer, so are you.
When someone knowingly or willingly lies in order to get paid, this is fraud - and a federal crime. Such a crime happens when a provider misrepresents on the claim form what was furnished to the consumer.
If you are a patient, and suspect that Medicare has improperly paid a claim, contact the phone number on your Explanation of Medicare Benefits (EOMB). If you wish, your name will not be used. The insurance company will investigate the claim, and determine if an error was made.
Sometimes, you are billed for services from doctors whose names you may not recognize. This usually happens when a radiologist or cardiologist interprets a test that you were given.
In looking for Medicare fraud, be alert to:
- Duplicating payment for the same service.
- Ambulance Services you are not aware of.
- Dates of service on the EOMB that differ from the dates you were treated.
- Outpatient services billed while the patient was in the hospital.
- Items or services you do not recall getting.
If you believe Medicare is being cheated, call or write the Medicare company that paid the claim. The name, address and telephone number are on the Explanation of Your Part B Medicare Benefits or call 1-800-333-7586.
Return to Main Page, Wound Care Institute Newsletter, Fall 1996
