What is Medicare fraud?
It is fraud when Medicare is billed for services or supplies you never receive. Medicare loses billions of dollars to fraudulent claims every year.
What are some examples of Medicare fraud?
- A healthcare provider bills Medicare for services you never received.
- A supplier bills Medicare for equipment you never got.
- Someone uses your Medicare card to get medical care, supplies, or equipment.
- A company offers a Medicare drug plan that has not been approved by Medicare.
- A company uses false information to mislead you into joining a Medicare plan.
Why is it important to stop Medicare fraud?
Medicare fraud results in higher health care costs for everyone. Eliminating fraud cuts costs for families, businesses, and the federal government. It also increases the quality of services for those who need care.
What can we do to stop Medicare fraud?
Stopping fraud requires cooperation from everybody—the federal government, state governments, health care providers, insurers, law enforcement, and citizens like you. Currently, four key programs are support the effort to crack down on Medicare fraud:
- The Affordable Care Act
The Act, also known as the health care reform law, includes powerful steps toward fight health care fraud, waste, and abuse. Through its programs, the government has recovered more than $10 billion in the last three years.
- Health Care Fraud Prevention and Enforcement Action Team (HEAT)
This joint effort between the Department of Health and Human Services and Department of Justice brings together senior officials to lead Medicare Strike Force teams that raise the fight against fraud to a new level.
- Senior Medicare Patrols
The administration has added new funding for Senior Medicare Patrols. These groups of senior citizen volunteers educate their peers to identify, prevent, and report health care fraud.
- Public-Private Partnership to Prevent Health Care Fraud
This ground-breaking partnership unites public and private organizations in the fight against health care fraud. The voluntary, collaborative partnership includes the federal government, state officials, several leading private health insurance organizations, and other anti-fraud groups.
What successes have the anti-fraud efforts had so far?
- The government recovered a historic $4.1 billion in 2011, resulting in more than $10 billion recovered since 2008.
- In its first year of implementation, the Centers for Medicare and Medicaid’s Fraud Prevention System:
- Generated leads for 538 new fraud investigations
- Provided new information for 511 existing investigations
- Triggered 617 provider interviews and 1,642 beneficiary interviews
- In October 2012, Medicare Strike Force operations in seven cities led to charges against 91 individuals—including doctors, nurses, and other licensed medical professionals—for their alleged participation in Medicare fraud schemes involving approximately $432 million in false billing.
You can help
Learn how to prevent fraud.