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Medicare and Medicaid Fraud and Abuse

Medicare is a federal program that provides medical coverage to elderly and disabled people. Medicaid is a state-administered program that provides medical coverage to low-income people. The Coalition Against Insurance Fraud reports that, in 2007, Medicare and Medicaid lost about $23.7 billion dollars due to improper payments.

  1. What Is Fraud?

    • Medicare and Medicaid fraud includes billing for services that were never received, billing for durable medical equipment like wheelchairs or hospital beds after they have been returned and using another person's Medicare or Medicaid card to receive medical care.

    Why Does It Occur?

    • Sometimes health care providers simply make mistakes when billing Medicare and Medicaid but some providers try to cheat the system. An article in the October 28, 2009 issue of "The Wall Street Journal" reported that Medicare only reviews about three percent of the claims they receive, so it is easy for false claims to be approved.

    Preventing Fraud

    • Medicare.gov states that Medicare recipients should be wary of health care providers who promise free services in exchange for giving them your Medicare number. Also be wary of providers who say a particular service is not usually covered by Medicare or Medicaid but they know how to get Medicare or Medicaid to pay for it.

    Detecting Fraud

    • Any time you receive medical care that is covered by Medicare or Medicaid, you will receive a benefits summary. Review the summary carefully to make sure Medicare or Medicaid was not billed for any services you did not receive.

    Reporting Fraud

    • If you suspect your health care provider has billed Medicare or Medicaid incorrectly, you should first discuss the matter with the provider. If you are not satisfied, call the Office of Inspector General's National Fraud Hotline at 1-800-447-8477.

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