HOW TO REPORT FRAUD

From HCFA’s Medicare Fraud & Abuse Website

If you believe Medicare is being ripped-off, call or write the Medicare company that paid the claim. The name, address, and telephone number are on the Medicare explanation of benefits which shows what Medicare paid.

Before contacting the Medicare claims processing company, carefully review the facts as you know them and as shown on explanation of benefits. Write down:

• The provider’s name and any identifying number you may have.
• The item or service you are questioning.
• The date on which the item or service was supposedly furnished.
• The amount approved and paid by Medicare.
• The date of the explanation of benefits.
• The name and Medicare number of the person who supposedly received the item or service.
• The reason you believe Medicare should not have paid
• Any other information you may have showing that the claim for the item or service should not have been paid by Medicare.

If you plan to write rather than call, clearly state at the beginning of your letter that you are filing a fraud complaint. This will help to ensure that your complaint is forwarded to the fraud unit.
 

Fraud Tips - Be suspicious of the provider that tells you:

• The test is free; he only needs your Medicare number for his records.
• 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:

• Routinely waive copayments without checking on your ability to pay.
• Advertises "free" consultations to Medicare beneficiaries
• Claim they represent Medicare.
• Use pressure or scare tactics to sell you high priced medical services or diagnostic tests.

BE SUSPICIOUS OF:

• Home health providers that offer non-medical transportation services or housekeeping as Medicare approved services
• Physicians who bill Medicare for telephone calls, conferences with the family, or scheduled but not kept appointments.
• Physicians who bill Medicare for a routine check-up.
• Ambulance companies that bill for trips which are not emergency in nature.
• Home health providers bill for Medicare patients who still drive an automobile.
• Suppliers that bill Medicare for medical equipment for beneficiaries in nursing homes.
• Hospital providers that bill Medicare for Medical equipment for tests you received as an inpatient or within 72 hours of admission or discharge.

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