Medicare Fraud 2023

Unfortunately, Medicare fraud is on the rise. One type of Medicare fraud that is especially common nowadays is fraudulent billing for sham tests, equipment, and procedures. This type of fraud is very lucrative to fraudsters. Moreover, since it doesn’t directly affect Medicare beneficiaries’ bottom line, it often goes unnoticed by the public. Typically, the United States Department of Justice must step in to investigate and prosecute these cases. And the consequences are dire. Medicare fraud costs the government billions of dollars and results in higher premiums for everyone. It can also affect the health coverage you receive. However, there is an easy way you can help contribute to the successful prosecution of these cases. Keep reading if you are interested in being the strongest link.

Here is a quick synopsis of some of these scams. The government loses about $100 billion dollars each year to Medicare fraud. This includes billing for phony COVID tests, billing for wheelchairs for patients who don’t need them or who don’t even exist, and fake tests, including fake cancer screenings. And it’s easy. For example, one can repackage the same pills and sell them back and forth amongst providers and patients who are in on the scheme, all while billing Medicare as if these were new batches of pills and new patients being provided services. One South Florida man who used to make a living ripping off Medicare said to reporters at CNBC that “[i]t’s just so easy. It’s unbelievable.” While this man was ultimately caught and entered a plea deal where he had to serve 3 years in prison, he raked in millions of dollars before then. 

You might be asking how this can be stopped when it is so prevalent. The answer is easy. You, the Medicare Beneficiary, can check your Medicare Summary Notice (MSN) and Explanation of Benefits (EOB) to confirm that the services billed were received by you. For those that don’t know, MSNs and EOBs are given to all Medicare beneficiaries and explain what the health care provider billed for, the amount approved by Medicare, what Medicare paid and what the beneficiary might be billed. By checking these notices on receipt, you can catch services that were billed to Medicare by fraudsters that you didn’t receive or that were more costly than the service you received. 

Once you catch these instances of fraud, it is easy to report them. Simply report them to your local SMP, who can analyze them and refer them to the appropriate law enforcement agency. For you Colorado readers out there, your local SMP is the Colorado Department of Regulatory Agencies, Division of Insurance, and you can call them at 1-800-503-5190. If you don’t want to report the suspected fraud to your SMP, you can also call local law enforcement, call 1-800-Medicare, or call the US Department of Health and Human Services Office of the Inspector General (OIG). You can reach the OIG by calling 1-800-HHS-TIPS (1-800-447-8477).

And of course, you can always call Benefits in Action if you need to learn more about Medicare fraud and how to report it. We are a Senior Health Insurance Assistance Program (SHIP) site. Our unbiased SHIP counselors can provide information about Medicare fraud. Not only that, but Benefits in Action also provides a host of other services as well. So, if you are interested in learning more about Medicare fraud or the other services provided by Benefits in Action, call 720-221-8354 or email Until next month, stay healthy and stay safe.

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