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What Is Medicare Fraud?

Medicare fraud occurs when a health-care provider knowingly bills Medicare for goods or services that were not provided, or when one person uses another person's Medicare card to receive health care for which he or she would not qualify.

  1. Significance

    • According to the Centers for Medicare and Medicaid Services, fraud is responsible for the Medicare program losing millions of dollars each year; however, an article published in The Economist suggests that Medicare loses more than $60 billion per year as a result of fraud.

    Government Efforts

    • In 2009, the government recovered $2.9 billion that it said had been billed fraudulently. In 2010, the Department of Health and Human Services and the Department of Justice formed the Health Care Fraud Prevention and Enforcement Team.

    Prevention/Solution

    • If you are a Medicare recipient, you can help prevent fraud by closely reviewing each Medicare Summary Notice, sometimes called an Explanation of Benefits, that you receive. If a charge doesn't seem right to you, contact the health-care provider and ask about it. Many mistakes on Medicare bills are legitimate errors, but if the health-care provider is evasive or unhelpful, and you suspect fraud, report the matter to Medicare (1-800-MEDICARE) or to the Department of Health and Human Services (1-800-447-8477).

    Penalties

    • Health-care providers convicted of fraud are required to repay Medicare the amount defrauded. In addition, they face stiff fines and the possibility of jail time if they are prosecuted through the criminal justice system.

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