Fighting Medicare fraud
Recently, while sitting at home on a Sunday afternoon, I received an email from a concerned friend asking about a potential Medicare scam. His mother had received a call from someone claiming to be from Medicare who was offering to provide some free medical equipment. All that was needed to complete the transaction was a Medicare number. I quickly replied that the phone call was indeed a scam because no one from Medicare would ever call and ask you to provide your Medicare number.
Health care fraud is a serious problem affecting communities across the country. It has many faces, and criminals are becoming more sophisticated in their efforts to scam the system. Although it is rare, some of the most troubling cases involve medical professionals – the same individuals with whom we entrust our care. While the majority of providers are honest, the very small percentage that are not can cost taxpayers billions of dollars and put beneficiaries’ health and well-being at risk. Health care fraud drives up costs for everyone in the system and endangers the future of programs more than 100 million Americans depend on every day.
Maintaining the integrity of the Medicare program is a top priority for the Centers for Medicare and Medicaid Services (CMS). With our law-enforcement partners, we have put in place a set of comprehensive measures to fight fraud and abuse, and our efforts are paying off. In 2011, together, we recovered a record $4.1 billion in taxpayer dollars.
Providers and suppliers who want to participate in Medicare must now pass a tougher set of screening procedures. High-risk categories of providers and suppliers receive additional scrutiny before they’re able to bill Medicare, Medicaid and the Children’s Health Insurance Program. CMS also has new authority to suspend payments during fraud investigations.
Those individuals who commit fraud face tougher rules and sentences. New penalties for individuals engaging in Medicare fraud and abuse reflect the seriousness of the crimes, with sentences between 20 and 50 percent longer for the biggest offenses. From 2008 to 2011, there was a 75 percent increase in individuals charged with criminal health care fraud.
CMS has also implemented a new Fraud Prevention System that uses predictive modeling technology, similar to the technology that credit card companies use to flag suspicious activity, to review medical claims before they are paid. Since the technology was first introduced in 2011, all Part A and B Medicare claims – more than 1 billion – have run through the system. During the first year, the system initiated 536 new investigations and helped stop, prevent or identify an estimated $115 million in fraudulent payments.
These changes are making a difference, but our most important ally in the fight against fraud is you – the health care consumer. Here are a few ways you can guard your benefits and join us in the fight against fraud:
-Guard your Medicare number. Do not share it with anyone other than your doctor or other Medicare-approved health care provider.
-Don’t give credit card or other financial information to anyone calling saying he or she represents Medicare. Medicare will never call and ask for your bank accounts or credit card numbers, and we also never ask people for their Social Security or Medicare numbers in a blind call.
-Never use another person’s Medicare card or allow anyone else to use yours.
-Beware of suspicious activities. Do not allow anyone except your doctor or other Medicare-approved provider to review your medical records or recommend services.
-Never let anyone give you “free” equipment or supplies in exchange for your Medicare number.
-Review your Medicare Summary Notice thoroughly to ensure you received each service listed and all the details are correct.
-Report any and all suspicions of fraud by calling 1-800-HHS-TIPS or 1-800-MEDICARE.
To learn more about health care fraud and ways to protect against it, visit www.stopmedicarefraud.gov.
Ray Hurd is the acting regional administrator of CMS’ New York Regional Office. CMS is a federal agency within the U.S. Department of Health and Human Services that administers Medicare and works with states to administer Medicaid, the State Children’s Health Insurance Program and health insurance portability standards. It also oversees standards for nursing homes and the Health Insurance Portability and Accountability Act.