Most Medicare payment errors are simple mistakes and are not the result of physicians, providers, or suppliers trying to take advantage of the Medicare system. Some institutions or individuals, however, abuse or defraud Medicare, cheating the program (and in some cases the people with Medicare who are liable for co-payments) out of millions of dollars annually. This page is dedicated to helping you to help Medicare to avoid making inappropriate payments to fraudulent entities:

What is Fraud?
Medicare fraud is purposely billing Medicare for services that were never provided or received. Some examples of Medicare fraud include:

• Billling Medicare or another insurer for services or items you never got.
• Billing Medicare for services or equipment which are different from what you got.
• Use of another person’s Medicare card to get medical care, supplies, or equipment.
• Billing Medicare for home medical equipment after it has been returned.

Detection Tips:
You should be suspicious if the provider tells you that:

• The test is free; he only needs your Medicare number for his records. NOTE: For clinical laboratory tests, there is no co-payment and a provider may in good faith state that the test is free, since there is not cost to the person with Medicare.
• Medicare wants you to have the item or service.
• They know how to get Medicare to pay for it.
• The more tests they provide the cheaper they are.
• The equipment or service is free; it won't cost you anything.

Be suspicious of providers that:

• Charge co-payments on clinical laboratory tests, and on Medicare covered preventive services such as PAP smears, prostate specific antigen (PSA) tests, or flu and pneumonia shots.
• Routinely waive co-payments on any services, other than those previously mentioned, without checking your ability to pay.
• Advertise "free" consultations to People with Medicare.
• Claim they represent Medicare.
• Use pressure or scare tactics to sell you high priced medical services or diagnostic tests.
• Bill Medicare for services you did not receive.
• Use telemarketing and door-to-door selling as marketing tools.

Prevention Tips
To help prevent Medicare fraud, you should report suspected instances of fraud. Whenever you receive a payment notice from Medicare, review it for errors. The payment notice shows what Medicare was billed for, what Medicare paid and what you owe. Make sure Medicare was not billed for health care services or medical supplies and equipment you did not receive. People who uncover medicaid fraud may be able to collect an award for their efforts under the Qui tam provisions of the False Claims Act (31 U.S.C. § 3729 et seq.).  This "whistleblower statute" which allows for a private individual, or whistleblower with knowledge of past or present fraud on the federal government to bring suit on behalf of the government.  If you think you know of any Medicaid fraud, please fill out the form below. An attorney will review your claim and may contact you to discuss your rights.