How to Report Medicare Fraud
Study your claim forms., Call your doctor., Collect details about the activity., Contact the nearest SMP program., Submit a fraud report to the appropriate agency.
Step-by-Step Guide
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Step 1: Study your claim forms.
If you suspect fraud or abuse, study the entries on your claim forms and compare them to earlier records.
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. -
Step 2: 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.
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., Before you submit your report, gather as many details as possible about the charges you believe are fraudulent.
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.Fraud ranges from broad-based operations by nationwide institutions to individual health care providers working on a small scale., The Senior Medicare Patrol investigates fraud and can assist you in filing your report as well as answering any questions you have.The SMP also can help you if you don't feel comfortable talking to your health care provider or supplier, or if you intend to remain anonymous and don't want them to know you have any suspicions.If you don't know how to contact SMP, you can use the SMP locator at http://www.smpresource.org/Locator/Default.aspx?State=. , If you're not satisfied with the responses you've received from your health care provider, you should let alert state authorities to your suspicions.
You also may be able to report fraud to your local police department. -
Step 3: Collect details about the activity.
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Step 4: Contact the nearest SMP program.
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Step 5: Submit a fraud report to the appropriate agency.
Detailed Guide
If you suspect fraud or abuse, study the entries on your claim forms and compare them to earlier records.
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.
If you find a discrepancy, call your doctor before you report fraud to make sure the questionable charges weren't made in error.
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., Before you submit your report, gather as many details as possible about the charges you believe are fraudulent.
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.Fraud ranges from broad-based operations by nationwide institutions to individual health care providers working on a small scale., The Senior Medicare Patrol investigates fraud and can assist you in filing your report as well as answering any questions you have.The SMP also can help you if you don't feel comfortable talking to your health care provider or supplier, or if you intend to remain anonymous and don't want them to know you have any suspicions.If you don't know how to contact SMP, you can use the SMP locator at http://www.smpresource.org/Locator/Default.aspx?State=. , If you're not satisfied with the responses you've received from your health care provider, you should let alert state authorities to your suspicions.
You also may be able to report fraud to your local police department.
About the Author
Mark Griffin
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