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SENIOR INFORMATION BULLETIN
The
following information and fraud prevention tips are from the Health Care
Financing Administration (HCFA). For
additional information, visit the official US Government site for Medicare
information - www.medicare.gov
This web site, established by HCFA, has useful information for Medicare
beneficiaries and those involved in helping them with their health care
decisions.
Medicare fraud includes,
but is not limited to:
¨
Billing for
more expensive services at a higher service fee than was provided.
¨
Falsifying
certificates of medical necessity, plans of treatment, and medical records to
justify payment.
¨
Billing for
services not furnished.
¨
Soliciting,
offering, or receiving a kickback.
¨
Billing
separately for services that should be included in a single service fee.
¨
Misrepresenting
the diagnosis to justify payment.
Protect yourself against
health care fraud:
ü
Never give
your Medicare or Medicaid numbers over the telephone or to people you do not
know.
ü
Beware of
health care providers and suppliers that use telephone calls and door- to - door
selling as a way to sell you goods or services.
ü
Be
suspicious of companies that offer free medical equipment or offer to waive your
co- payment without first asking about your ability to pay.
ü Beware of health care providers who say they represent Medicare or a branch of the Federal government, or providers who use pressure tactics to get you to accept a service / product.
You should be suspicious
if the provider tells you that:
·
The test is
free; they only need your Medicare number for their records.
·
Medicare
wants you to have the item or service.
·
They know
how to get Medicare to pay for it.
·
The more
tests provided, the cheaper they are.
·
The
equipment or service is free; it won't cost you anything.
Be suspicious
of…
v
Home health
providers that offer non-medical transportation services or housekeeping as
Medicare approved services.
v
Ambulance
companies that bill Medicare for non-emergency trips.
v
Suppliers
that bill Medicare for medical equipment for beneficiaries in nursing
homes.
v Physicians that give the wrong diagnosis on the claim form so Medicare will pay.
Reporting Medicare fraud
and abuse:
If
you have a questionable charge on your bill, call the provider, your Fiscal
Intermediary (for Part A bills) or your Medicare carrier (for Part B bills).
If you believe that a health care provider may be cheating or abusing the
Medicare program, call the Medicare carrier or intermediary that sent you the
payment notice. Their name,
address, and telephone number appear on the payment notice.
After you call the Medicare carrier or Fiscal Intermediary, you may also call the Inspector General's hotline at 1-800-HHS-TIPS (1-800-447-8477), or TTY for the hearing and speech impaired: 1-800-377-4950.