Medicare Fraud and Abuse Prevention

A podiatrist billed Medicare for services never provided.
Doctors provided unnecessary procedures and billed Medicare for them.
A pharmacist billed Medicare for prescriptions never dispensed to customers.
A clinic charged Medicare for infusion therapy never delivered to clients.
Owners of a nursing home diverted funds from Medicare and Medicaid to buy cars instead of basic necessities for their residents.

Most healthcare providers are honest in their billing.  Doctors don’t usually lie to insurance companies, and other clinicians don’t usually try get more than what they deserve.  However, there have been more than just a few fraudulent claims that Medicare and Medicaid have paid.  In fact, American taxpayers lose nearly $60 billion each year to outright scams, improper payments, and other illegal practices.  Just recently I learned that 61% of Medicare-provided power wheelchairs were medically unneeded or undocumented, costing $95 million in just six months.  The US Administration on Aging (AoA), the US Department of Health and Human Services (HHS), the Department of Justice (DOJ), and Centers for Medicare and Medicaid Services (CMS) are actively addressing this issue.  A press release from HHS and DOJ from June 17, 2011 stated:
In FY 2010, more than $4 billion was returned to the Medicare Health Insurance Trust Fund, the U.S. Department of the Treasury and others as a result of enforcement activities targeting false claims and fraud perpetrated against government health care programs.

If you suspect Medicare fraud, contact:

Office of Inspector General: 1-800-HHS-TIPS
email: HHSTips@oig.hhs.gov

Centers for Medicare and Medicaid: 1-800-Medicare/1-877-486-2048

Georgia Cares: 1-800-669-8387
website: www.mygeorgiacares.org

To learn more, visit: www.cms.gov