In the past two months, the Medicare Fraud Strike Force has recovered $371 million in false Medicare claims and charged 145 people across the US. On July 29, the Strike Force arrested 32 doctors and health care executives in the Houston area. The suspects were charged with submitting over $16 million in false Medicare claims.

The Houston Medicare fraud bust targeted scams such as "arthritis kits," which were expensive orthotics that included knee and shoulder braces and heating pads. Many patients either didn't need these or never received them even though health care clinic owners billed between $3,000 and $4,000 for each kit. Another scam involved billing Medicare for liquid food for patients but not distributing the food to the patients.

The FBI, the Health and Human Services Office of Inspector General, the Drug Enforcement Administration and the Texas Attorney General's Medicaid Fraud Control Unit all participated in the Houston bust.

What Is Medicare Fraud?

Medicare fraud is when physicians, providers or suppliers purposely bill Medicare for services or equipment that was never provided or received. Con artists either fake signatures or bribe corrupt doctors to sign the forms certifying equipment or services are needed. Medicare is then billed for unordered merchandise or never received services.

Some examples of Medicare fraud are:

  • Billing Medicare or another insurer for services or items you never received
  • Billing Medicare for services or equipment different from what you actually received
  • Using another person's Medicare card to get medical care, supplies or equipment
  • Billing Medicare for home medical equipment after it has been returned

How to Avoid Medicare Fraud

Senior citizens are usually the target of Medicare scams, especially by medical equipment manufacturers who offer seniors free medical products in exchange for their Medicare number. There are a number of things you can do to avoid being a victim of Medicare fraud:

  • Don't ever give out your Medicare number to anyone other than your physician or Medicare provider
  • Don't give blanket authorization to a medical provider to bill for services rendered
  • Always ask your medical providers what they will charge and what you are expected to pay out-of-pocket
  • Always review your insurer's explanation of the benefits statement and call your insurer or medical provider if you have questions
  • Avoid door-to-door or telephone salespeople who try to sell you a Medicare health plan or a prescription drug plan
  • Keep accurate records of all health care appointments
  • Always check with Medicare to make sure a company is legitimate before you sign a contract or give out any personal information
  • Avoid health care providers who tell you that an item or service is not usually covered but they know how to bill Medicare to get it paid

Report Suspected Scams or Abuse

Always report suspected instances of fraud. Whenever you receive a payment notice from Medicare, review it for errors. The payment notice shows what Medicare was billed for, what Medicare paid and what you owe. Make sure Medicare was not billed for health care services or medical supplies and equipment you did not receive.

If you don't remember a procedure that is listed, you should first call the physician, provider or supplier listed on the notice to discuss your bill and find out if a mistake was made. If your physician, provider or supplier is uncooperative or you can't reach them and you suspect fraud, you should call or write to the Medicare company that paid the claim.

In addition, you can contact the Health and Human Services Office of Inspector General by phone at 800-HHS-TIPS (1-800-447-8477), by e-mail at HHSTips@oig.hhs.gov or by mail at:

Office of the Inspector General
HHS TIPS Hotline
P.O. Box 23489
Washington, DC 20026

Questions for Your Attorney

  • What should I do if my health care provider billed Medicare for equipment but I never received it?
  • My medical provider billed Medicare several times for the same wheelchair, should I notify anyone about this or is it between the medical provider and Medicare and not my concern?
  • Should I be suspicious if a health care provider tells me a clinical laboratory test is free and they only need my Medicare number for their records?

Tagged as: Insurance, Medicare and Medicaid, medicare strike force, medicare fraud, medicare medicaid lawyer