Medicare fraud and abuse

According to the Centers for Medicare & Medicaid Services, fraud and billing mistakes cost Medicare and taxpayers an estimated $42 billion in 2020.1

Here are some tips to help you identify, report and prevent Medicare fraud and abuse.

How to spot Medicare fraud or abuse

What to look for

Common signs of Medicare fraud and abuse include getting:

  • Billed for services or equipment you didn't receive
  • Promised cheaper services or testing
  • Pressured to have unnecessary services performed or to receive unnecessary supplies
  • Charged a copay when you don’t owe one, or getting a copay waiver when you don’t qualify for one
  • Calls or visits by an uninvited person or company selling Medicare plans
  • Lied to about the services or benefits you will receive under your plan

What you can review

Double-check all of your Medicare documents for errors:

  • Compare the dates, services and charges on your calendar with the statements you get from Medicare. These include the Medicare Summary Notice (MSN), opens new window if you have Original Medicare , or similar statements if you're in a Medicare Advantage plan.
  • Review all receipts and statements from providers for mistakes.
  • Check your claims early—the sooner you see and report errors, the sooner you can help stop fraud.

How to report Medicare fraud or abuse

You have several ways to report suspected Medicare fraud or abuse:

  • For Original Medicare (Parts A and B), call the Centers for Medicare & Medicaid Services at 800-MEDICARE (800-633-4227, TTY: 877-486-2048)
  • If you’re enrolled in a Medicare Advantage plan (Part C), find your plan's general contact and/or fraud-reporting information
  • If you’re enrolled in a Medicare drug plan (Part D), call the Medicare Drug Integrity Contractor (MEDIC) at 877-7SAFERX (877-772-3379) or find your plan's general contact and/or fraud-reporting information

For a faster and easier experience, try to have this information ready before you call:

  • Your name and Medicare number
  • The healthcare provider's name and any other information you have
  • The service or item in question and when it was given
  • The payment amount approved and paid by Medicare
  • The date on your Medicare Summary Notice or claim

Tips to prevent Medicare fraud or abuse

Here are some things you can do to stop fraud and abuse before it starts:

  • Protect your identity – Never share your Social Security number, bank account numbers or Medicare number with someone you don’t trust.
  • Keep your medical records safe – Don’t allow anyone except your doctor or Medicare provider to review your medical records.
  • Ask questions – Call your doctor, Medicare provider or insurance company and ask them about any mistakes you find.
  • Know your rights – As a person on Medicare, you have certain rights and protections, opens new window to help protect you.

Help Humana fight fraud, waste and abuse

At Humana, we have an ongoing commitment to detecting, correcting and preventing issues like fraud and abuse. For more information, check out how we’re addressing fraud, waste and abuse.

Sources

  1. “2020 Estimated Improper Payment Rates for Centers for Medicare & Medicaid Services (CMS) Programs,” Centers for Medicare & Medicaid Services, last accessed April 1, 2021, https://www.cms.gov/newsroom/fact-sheets/2020-estimated-improper-payment-rates-centers-medicare-medicaid-services-cms-programs, opens new window.

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