What exactly is Healthcare Fraud?
Healthcare fraud is when someone is misleading so they can get an unauthorized payment or benefit. Examples of health care fraud include:
• Billing for services never performed or medical equipment or supplies not ordered.
• Billing for services or equipment that are different from what was provided or was returned.
• DOUBLE BILLING - charging more than once for the same service.
• UPCODING - billing for a more expensive or covered item when a less expensive, non-covered item was provided.
• UNBUNDLING - billing related services separately to charge a higher amount than if they are combined and billed as one service or group of services.
• Falsely claiming that services are medically necessary when they are not.
• Using another person’s Medicare card to get medical care, supplies, or equipment.
• Soliciting, offering or receiving bribes, rebates or kickbacks. (A kickback is an arrangement between two parties which involves an offer to pay for Medicare business.)
What can you do to prevent healthcare fraud?
• Never give any personal information (such as your Medicare or Medicaid, Social Security, bank account or credit card numbers) over the telephone or to people you do not know who come to the door or call you on the phone.
• Never give your Medicare/Medicaid number in exchange for free medical equipment or any other free offer.
• Always keep a record of your health care appointments and the services.
• The payment notice shows what services or supplies were billed to Medicare, what Medicare paid, and what you owe. Look for any charges that seem wrong to you – charges for something you did not get, billing for the same thing twice, or services not ordered by your doctor.
• If you spend time in a hospital, make sure the admission date, discharge date, and diagnosis on your bill are correct. Always inventory medical supplies and check against your statement.
• Be suspicious if a provider tells you that:
• The equipment, service or test is free.
• The provider knows how to get Medicare to pay for items or services, even if they are not usually covered.
• They claim to represent Medicare, or they have been endorsed by the federal government.
• Use telemarketing and door-to-door selling as marketing tool.
• Advertise "free" consultations to people on Medicare or offer “free” testing or screening in exchange for your Medicare card number, just for their records.
• Use pressure or scare tactics to sell you high-priced medical services or diagnostic tests.
• Charge co-payments on clinical laboratory tests, and on Medicare covered preventive services such as PAP smears, prostate specific antigen (PSA) tests, or flu and pneumonia shots.
If you think you have been the victim of fraud
• Call the healthcare provider or supplier first to question the charge. If it was a mistake, ask them to correct it.
• If the provider or supplier cannot answer the question, call the company that paid the bill. Their contact information can be found on your Medicare Summary Notice or Explanation of Benefits.
• Call the Connecticut SMP at 1-800-994-9422 if the issue cannot be fixed or you think it may be fraud or abuse. The Senior Medicare Patrol can assist you and can help refer cases to the proper authorities when necessary.
NOTE: If you feel threatened by someone who is trying to steal your money or personal information – immediately call your local police or 911.