Medicare Fraud - What You Can Do To Help Prevent It


I read some interesting AARP articles regarding Medicare fraud and thought I’d share. 


Below are some excerpts:

"Each year, roughly 10 cents of every dollar budgeted for the giant health insurance program is stolen or misdirected before it helps any enrollee. Looked at another way, about $1,000 is lost per Medicare member through theft or waste each year. That is according to the federal government’s reckoning. But it could be far worse. Malcolm Sparrow, a Harvard University professor and leading expert on health care fraud, says the true amount lost to fraud, abuse or improper payments could be 20 percent, or even as high as 30 percent.”1

It’s not just taxpayers who pay the price. Medicare beneficiaries also foot the bill in the form of higher deductibles and copayments, and cuts to services and care. Put simply, fraud is directly harming the health of older Americans and compromising the program.”1

"Fraudsters often:

Charge for services never delivered
Falsify records
Inflate claims
Steal your ID
File duplicate claims
Provide unneeded equipment
Buy off doctors/patients
Shortchange your care" 1


Below are just a few of the tips they suggested to protect yourself:

  • "Review your Medicare Explanation of Benefits statements. Verify that each of the items on your statement was provided on the date listed and from the provider indicated. 
  • Call the Medicare hotline at 800-633-4227 if you have questions about your statement or think an adjustment is in order. 
  • Report it to authorities if you spot a charge that does not look legitimate or if you become aware of what appears to be fraudulent Medicare activity. The contact is the hotline at the HHS Office of Inspector General, 800-447-8477. All calls are handled confidentially. If you suspect there is a fraudulent charge to your prescription plan (Medicare Part D), the toll-free number to call is 877-772-3379.
  •  Write a letter with any complaints to: U.S. Department of Health and Human Services Office of Inspector General, Attention: OIG Hotline Operations, P.O. Box 23489, Washington, D.C. 20026.
  •  Alert the government: Health care providers who know of fraud or waste should report it by calling 800-447-8477.”2



To read the articles, click on the web links below.

  1. https://www.aarp.org/money/scams-fraud/info-2018/medicare-scams-fraud-identity-theft.html
  2. https://www.aarp.org/money/scams-fraud/info-2018/medicare-fraud-identity-theft-scam.html
  3. https://www.aarp.org/money/scams-fraud/info-2018/medicare-strike-force.html
  4. https://www.aarp.org/money/scams-fraud/info-2018/how-to-avoid-medicare-scams.html


1. Source: AARP Bulletin April 2018 - Cover Story Fraud - Medicare Under Assault Page 10,
https://www.aarp.org/money/scams-fraud/info-2018/medicare-scams-fraud-identity-theft.html

2. Source: AARP Bulletin April 2018 - Medicare Fraud: Taking A Stand Page 22, https://www.aarp.org/money/scams-fraud/info-2018/how-to-avoid-medicare-scams.html



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