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Medicare
defines Medicare Fraud as "an intentional deception or misrepresentation that the individual knows to be
false or does not believe to be true, and makes knowing
that the deception could result in some unauthorized benefit
to himself/herself or some other person. The
most frequent kind of fraud arises from a false statement made,
or caused to be made, that is material to entitlement
to the Medicare program. The violator may be a participating provider,
a beneficiary, or some other person or business entity."
Since Medicare
fraud involves "intent", or knowledge that what was done
was against the law, it generally is rare for a person with Medicare
to be able to determine this. True cases of fraud require investigation
by law enforcement. However, people with Medicare can identify when
a situation they experience or read on their Medicare Summary Notice
(MSN) is not correct, or does not seem right. Reporting these concerns
is where you can help to prevent Medicare fraud, waste, and abuse.
Some general
examples of Medicare fraud, waste, and abuse are:
- Services
that were not provided
- Services
that were not ordered by a physician
- Medicare
providers incorrectly reporting diagnoses or procedures on bills
to maximize payments
- Misrepresentations
(altering documentation) or making false statements of dates and
descriptions of services furnished, or the identity of the person
receiving Medicare services, or the individual who furnished the
services
- Creating
false claim and medical record information to obtain Medicare payment
- Receiving
a gift or "kickback" in exchange for someone to have inappropriate
access to your Medicare number
- Use
of another person's Medicare card to obtain medical care/payment
Additional
examples of Medicare fraud can be viewed by clicking on this attachment, "Current Medicare Fraud
Schemes" |
