Medicare Fraud Prevention

Information about preventing Medicare fraud activity.

Page updated on Sep 17, 2021 at 1:57 PM

VICAP             SMP             DARS


Medicare Fraud Prevention

Medicare loses billions of dollars because of billing errors, abuse, and fraud.  You can help to prevent Medicare waste and fraud and ensure that Medicare is around for generations to come. 


Errors

Medicare is a complex program with complicated rules and procedures which can lead to human error in processing and billing claims.

Example:

There are two beneficiaries with the same name and the charge was assigned to the wrong person. 

What can you do?

  • Always review your Medicare Summary Notice for errors and report any inaccuracies to your doctors billing office.

 

Abuse

Medicare abuse involves payment for items or services when there is no legal entitlement to that payment and the provider unknowingly or unintentionally misrepresented of the facts or diagnosis to get payment.

Example:

Billing Medicare for services that are not medically necessary or not provided.

What can you do?

  • Keep records of dates and services and compare them to your Medicare Summary Notice.
  • Report any inaccuracies to doctors billing office, Medicare (1-800-633-4227) or Senior Medicare Patrol at 1800-938-8885.

 

Fraud

Medicare fraud is intentional deception or misrepresentation that the individual knows to be FALSE and this deception could result in some unauthorized benefit to himself for herself or some other person.

Example:

Knowingly and intentionally billing for services or supplies that were not rendered with the objective to get payment.

What can you do?

  • Protect your Medicare and Social Security Numbers – don’t provide this information to anyone other than doctors or people you know should have it.
  • Do not accept unsolicited phone calls or respond to mailed offers.
  • Do not accept offers for “FREE” medical care.

Report any inaccuracies to doctors billing office, Medicare (1-800-633-4227) or Senior Medicare Patrol at 1800-938-8885.

 

Report errors, abuse, and fraud to:

  • 1-800 MEDICARE (1-800-633-4227)
  • Bureau of Insurance at 804-371-9741

Virginia SCC - File a Complaint

  • Senior Medicare Patrol at 1800-938-8885    

The Virginia SMP – VA Senior Medicare Patrol

 

Scans to watch out for:

https://virginiasmp.com/271-2/

   

Resources

Medicare is a federal government program that provides health care coverage for people over 65 or if under 65 and receiving Social Security Disability Insurance (SSDI) OR under 65 and diagnosed with End-Stage Renal Disease or Amyotrophic Lateral Sclerosis (ALS).

https://www.medicare.gov/

 

Virginia Senior Medicare Patrol (SMP) is a volunteer-based organization funded by the U.S. Department of Health and Human Services that expertise, training, and technical support to maximize the effectiveness of fraud/abuse prevention outreach and education. 

The Virginia Senior Medicare Patrol’s (SMP) mission is to empower and assist Medicare beneficiaries, their families, and caregivers to prevent, detect, and report health care fraud, errors, and abuse through outreach, counseling, and education.  The Virginia SMP works with local AAA’s and volunteers to provide information, conduct educational presentations and attend events to share information with the public.

Fraud Hotline: 1-800-938-8885

SMP Website: www.VirginiaSMP.com 

 

SMP Resource Center  provides education  on ways to prevent, detect, and report Medicaid error, abuse, and fraud.

https://www.smpresource.org/Content/Resources-for-SMPs/SMP-Resource-Center.aspx

 

Center for Medicare and Medicare Services (CMS) is the agency within the U.S. Department of Health and Human Services (HHS) that administers Medicare and Medicaid insurance. CMS collects and analyzes data, produces research reports, and works to eliminate instance of abuse and fraud within the healthcare system

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Fraud-Abuse-MLN4649244.pdf

 

Top