Report Medicare Fraud

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←Older revision		Revision as of 23:57, 23 June 2019
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	=== Reporting to Your State Medicare Agency ===		=== Reporting to Your State Medicare Agency ===
	#Study your claim forms. If you suspect fraud or abuse, study the entries on your claim forms and compare them to earlier records.[[Image:Report Medicare Fraud Step 1.jpg|center]]		#Study your claim forms. If you suspect fraud or abuse, study the entries on your claim forms and compare them to earlier records.[[Image:Report Medicare Fraud Step 1.jpg|center]]
−	#*When you visit your doctor or order medical supplies, record the dates yourself along with the services or supplies you will receive. Compare them with the information listed on the forms you receive from Medicare such as your Medicare Summary Notice.<ref>http://bit.ly/2X2ezJX>	+	#*When you visit your doctor or order medical supplies, record the dates yourself along with the services or supplies you will receive. Compare them with the information listed on the forms you receive from Medicare such as your Medicare Summary Notice.
−	#*If you find items on your Medicare forms that you have no record of, those items may be evidence of fraud.<ref>http://bit.ly/2X2ezJX>	+	#*If you find items on your Medicare forms that you have no record of, those items may be evidence of fraud.
	#Call your doctor. If you find a discrepancy, call your doctor before you report fraud to make sure the questionable charges weren't made in error.[[Image:Report Medicare Fraud Step 2.jpg|center]]		#Call your doctor. If you find a discrepancy, call your doctor before you report fraud to make sure the questionable charges weren't made in error.[[Image:Report Medicare Fraud Step 2.jpg|center]]
−	#*Simple clerical errors can be corrected, and typically don't rise to the level of intent required to prove either abuse or fraud. If the error is noted, your health care provider can correct it with Medicare and issue a new claim with the updated amount.<ref>http://bit.ly/2X2ezJX>	+	#*Simple clerical errors can be corrected, and typically don't rise to the level of intent required to prove either abuse or fraud. If the error is noted, your health care provider can correct it with Medicare and issue a new claim with the updated amount.
−	#*It also may be that you received a service without being aware of it, or that you don't understand the coding used and suspect the item on the Medicare claim form is incorrect when it actually is accurate.<ref>http://bit.ly/2X2ezJX>	+	#*It also may be that you received a service without being aware of it, or that you don't understand the coding used and suspect the item on the Medicare claim form is incorrect when it actually is accurate.
	#Collect details about the activity. Before you submit your report, gather as many details as possible about the charges you believe are fraudulent.[[Image:Report Medicare Fraud Step 3.jpg|center]]		#Collect details about the activity. Before you submit your report, gather as many details as possible about the charges you believe are fraudulent.[[Image:Report Medicare Fraud Step 3.jpg|center]]
	#*Examples of medicare abuse or fraud include suppliers billing Medicare for equipment you never ordered or received, or healthcare providers billing Medicare for services you were never provided.<ref>http://bit.ly/2JfUQNd>		#*Examples of medicare abuse or fraud include suppliers billing Medicare for equipment you never ordered or received, or healthcare providers billing Medicare for services you were never provided.<ref>http://bit.ly/2JfUQNd>
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	=== Reporting to the Office of the Inspector General ===		=== Reporting to the Office of the Inspector General ===
	#Contact your health care provider. If you find discrepancies on your claim form, check with your health care provider to make sure they aren't the result of an innocent error.[[Image:Report Medicare Fraud Step 6.jpg|center]]		#Contact your health care provider. If you find discrepancies on your claim form, check with your health care provider to make sure they aren't the result of an innocent error.[[Image:Report Medicare Fraud Step 6.jpg|center]]
−	#*Keep your own records of the health care services and supplies you receive, and make sure your Medicare forms have the same information listed as you have in your own records.<ref>http://bit.ly/2X2ezJX>	+	#*Keep your own records of the health care services and supplies you receive, and make sure your Medicare forms have the same information listed as you have in your own records.
−	#*Clerical errors can be corrected and the health care provider can submit a new claim form to Medicare with updated entries.<ref>http://bit.ly/2X2ezJX>	+	#*Clerical errors can be corrected and the health care provider can submit a new claim form to Medicare with updated entries.
	#Gather information for your report. Before you report suspected fraud, make sure you have enough information for the OIG to make a full investigation.[[Image:Report Medicare Fraud Step 7.jpg|center]]		#Gather information for your report. Before you report suspected fraud, make sure you have enough information for the OIG to make a full investigation.[[Image:Report Medicare Fraud Step 7.jpg|center]]
−	#*The OIG needs names and identifying information about your health care provider, the services you question and the date those services supposedly were provided, and the payment amount approved by Medicare.<ref>http://bit.ly/2X2ezJX>	+	#*The OIG needs names and identifying information about your health care provider, the services you question and the date those services supposedly were provided, and the payment amount approved by Medicare.
−	#*You also must be prepared to provide your name and Medicare number along with the reasons you believe the amount was in error and should not have been paid.<ref>http://bit.ly/2X2ezJX>	+	#*You also must be prepared to provide your name and Medicare number along with the reasons you believe the amount was in error and should not have been paid.
	#Learn the difference between fraud and abuse. Having a basic understanding of what constitutes fraud can help you avoid making false accusations.[[Image:Report Medicare Fraud Step 8.jpg|center]]		#Learn the difference between fraud and abuse. Having a basic understanding of what constitutes fraud can help you avoid making false accusations.[[Image:Report Medicare Fraud Step 8.jpg|center]]
	#*Abuse includes acts such as over-charging for services, or unbundling services, which happens when a health care provider charges separately for individual components of one service rather than the single charge for the service as a whole.<ref>https://go.cms.gov/2X2eBl3>		#*Abuse includes acts such as over-charging for services, or unbundling services, which happens when a health care provider charges separately for individual components of one service rather than the single charge for the service as a whole.<ref>https://go.cms.gov/2X2eBl3>
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	#*Another type of fraud involves health care providers receiving money in exchange for making referrals to another health care providers. This violates the federal Anti-Kickback Statute, which makes it a crime for health care providers to willfully pay or receive kickbacks for items or services reimbursable by Medicare.<ref>https://go.cms.gov/2X2eBl3>		#*Another type of fraud involves health care providers receiving money in exchange for making referrals to another health care providers. This violates the federal Anti-Kickback Statute, which makes it a crime for health care providers to willfully pay or receive kickbacks for items or services reimbursable by Medicare.<ref>https://go.cms.gov/2X2eBl3>
	#Contact the OIG. The OIG has the authority to exclude individuals and organizations who engage in Medicare fraud and abuse, as well as impose civil penalties for certain violations.<ref>https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/Fraud_and_Abuse.pdf</ref>[[Image:Report Medicare Fraud Step 9.jpg|center]]		#Contact the OIG. The OIG has the authority to exclude individuals and organizations who engage in Medicare fraud and abuse, as well as impose civil penalties for certain violations.<ref>https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/Fraud_and_Abuse.pdf</ref>[[Image:Report Medicare Fraud Step 9.jpg|center]]
−	#*You can call the national fraud hotline at 1-800-MEDICARE to report fraud to the OIG.<ref>http://bit.ly/2X2ezJX>	+	#*You can call the national fraud hotline at 1-800-MEDICARE to report fraud to the OIG.
	#*The OIG also has an online form you can fill out to report Medicare fraud. This form is available at http://bit.ly/2ekxrsw.		#*The OIG also has an online form you can fill out to report Medicare fraud. This form is available at http://bit.ly/2ekxrsw.
	#*When you report to the OIG, any identifying information you provide about yourself will remain confidential. The OIG won't tell your health care providers that you reported them. However, you also may enter your complaint anonymously.<ref>http://bit.ly/2X2eBS5>		#*When you report to the OIG, any identifying information you provide about yourself will remain confidential. The OIG won't tell your health care providers that you reported them. However, you also may enter your complaint anonymously.<ref>http://bit.ly/2X2eBS5>
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	#*While you make the decision whether to file your report anonymously, keep in mind that not including contact information may keep the OIG from completing a more comprehensive investigation since investigators cannot contact you if they hit a dead-end while reviewing your report and require further information.<ref>http://bit.ly/2J0ecpj>		#*While you make the decision whether to file your report anonymously, keep in mind that not including contact information may keep the OIG from completing a more comprehensive investigation since investigators cannot contact you if they hit a dead-end while reviewing your report and require further information.<ref>http://bit.ly/2J0ecpj>
	#*Your contact information is only shared within the federal Department of Health and Human Services for the purpose of investigating your report. Public disclosure of your information is prohibited by federal law.<ref>http://bit.ly/2X2eBS5>		#*Your contact information is only shared within the federal Department of Health and Human Services for the purpose of investigating your report. Public disclosure of your information is prohibited by federal law.<ref>http://bit.ly/2X2eBS5>
−	#*Under certain conditions, you may be eligible for a reward of up to $1,000 if you make a specific report of Medicare fraud that leads to the recovery of $100 or more of Medicare money.<ref>http://bit.ly/2X2ezJX>	+	#*Under certain conditions, you may be eligible for a reward of up to $1,000 if you make a specific report of Medicare fraud that leads to the recovery of $100 or more of Medicare money.
	== References ==		== References ==

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