Fraud, Waste and Abuse*
Although most physicians, providers, and suppliers who serve people with Medicare are committed to providing high quality care to their patients and to billing the program only for the payments they have earned, there are those who will try to abuse or defraud Medicare, cheating the program out of millions of dollars.
What is Medicare Fraud?
While there can be legitimate errors in billing, Medicare fraud is when a provider intentionally bills Medicare for services or products not provided or received. Some examples of fraud are:-
Billing Medicare for services or items you never received.
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Billing Medicare for services or equipment which are different from what you received.
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Use of another person's Medicare card to get medical care, supplies, or equipment.
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Billing Medicare for home medical equipment after it has been returned.
How Can I Tell if a Charge is Legitimate?
When you receive services or products that Medicare was billed for, you will receive a Medicare Summary Notice (MSN). The MSN shows what Medicare was billed for, what Medicare paid and what you owe. Review the notice for errors. Make sure the services or medical supplies and equipment that Medicare was billed for is what you received.What if I Suspect Fraud?
If you find a suspicious charge on you MSN, call your provider first. It could be a simple error that can be easily corrected. If you still suspect fraud after speaking with them, you can contact Scott & White Health Plan or contact the Office of Inspector General Hotline. The hotline offers a confidential means of reporting information.
Contact Scott & White Health Plan |
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| by phone: | 1-888-484-6977 TTY 1-866-220-2831 |
| by mail: |
Scott & White Health Plan |
| website: | www.scottandwhite.silentwhistle.com |
Contact Office of the Inspector General |
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| by phone: | 1-800-HHS-TIPS (1-800-447-8477) |
| by fax: | 1-800-223-2164 (no more than 10 pages please) |
| by e-mail: | HHSTips@oig.hhs.gov |
| by mail: |
Office of the Inspector General |
If you have specific information proving Medicare fraud, please provide as much identifying information as possible regarding your concern. Such information should include subject's name, address and phone number etc. Details regarding the allegation should include the basics of who, what, when, where, why, and how.
Please note that it is current Hotline policy not to respond directly to written communications.
How Can I Be Proactive in Preventing Fraud?
Because Medicare fraud costs the Medicare program millions of dollars annually, people with Medicare pay for it with higher premiums. You can help prevent, avoid and detect fraud by following some simple steps:-
Don't ever give out your Medicare Health Insurance Claim Number (on your Medicare card) except to your physician or other Medicare provider.
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Don't allow anyone, except appropriate medical professionals, to review your medical records or recommend services.
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Don't contact your physician to request a service that you do not need.
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Do be careful in accepting Medicare services that are represented as being free.
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Do be cautious when you are offered free testing or screening in exchange for your Medicare card number.
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Do be cautious of any provider who maintains they have been endorsed by the Federal government or by Medicare.
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Do avoid a provider of health care items or services who tells you that the item or service is not usually covered, but they know how to bill Medicare to get paid.
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Compare your MSN to the bill you get from your provider.
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If you are suspicious, contact the hotline.
How is Scott & White Health Plan Working to Minimize Fraud?
Scott & White health Plan utilizes fraud detection software for medical and prescription claims. Along with this software, we are in the process of implementing a Special Investigative Unit (SIU) as well as an additional auditor who will investigate any suspicious claims and follow necessary actions.*Source: medicare.gov. For more information, please visit the Medicare website at www.medicare.gov.
The above information is current as of May 2008.
SeniorCare is offered by Scott & White Health Plan, a State-Certified Health Maintenance Organization with a Medicare Cost Contract.
MCARE_FRAUD_SRCR2008
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