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Lesson 12: Medicare Fraud and Abuse

Medicare Fraud and Abuse

What Is Medicare Fraud & Abuse?

Fraud occurs when someone intentionally falsifies information or deceives Medicare. Abuse occurs when doctors or suppliers do not follow good medical practices, resulting in unnecessary costs to Medicare, improper payment, or services that are not medically necessary. 

A complaint about the quality of care you got from a doctor, hospital, or other provider or facility is not considered fraud or abuse. If you have a complaint about your quality of care, please click here.

Reporting Fraud

If you think a charge is incorrect and you know the provider, you may want to call their office to ask about it. The person you speak to may help you better understand the services or supplies you got. Or, your provider may realize a billing error was made.

If you`ve contacted the provider and you suspect that Medicare is being charged for a service or supply you didn`t get, or you don`t know the provider on the claim, call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

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Medicare.gov

Centers for Medicare & Medicaid Services
Baltimore , MD  21244-1850
http://www.medicare.gov

Phone: 1-800-633-4227
Phone Extension: N/A
Area(s) Served: Nationwide Contracted Provider: Not Applicable
Description:   Medicare.gov has all of the information and tools you need for questions or help with Medicare. You can: enroll in Medicare online compare and enroll in Medicare health or prescription plans find and compare doctors check to see if a test... read more
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Ohio Attorney General

30 E. Broad Street
Columbus , OH  43215
http://www.ohioattorneygeneral.gov/home.aspx/

Phone: 800-282-0515
Phone Extension:
Area(s) Served: Statewide Contracted Provider: Not Applicable
Description:   By law, the Attorney General is the chief law officer for the state of Ohio. The Office protects Ohio families from predatory financial practices through enforcement authority in the areas of consumer protection, antitrust, charitable organizations, ... read more
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Ohio Senior Medicare Patrol Project

7162 Reading Road
Cincinnati , OH  45237
http://www.proseniors.org/
Info@proseniors.org
Phone: (513) 345-4160
Phone Extension: N/A
Area(s) Served: Butler County,
Warren County,
Clermont County,
Statewide,
Clinton County,
Hamilton County
Contracted Provider: Not Applicable
Description:   Ohio SMP Is Seeking Volunteers Did you know that one out of every seven Medicare dollars goes to fraud, waste and abuse? That Medicare fraud, waste and abuse cost you $13 billion? To help address this national problem, Pro Seniors receives fund... read more
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Stop Medicare Fraud and Abuse

US Department of Health and Human Services
 
http://www.stopmedicarefraud.gov/

Phone: 800-447-8477
Phone Extension: N/A
Area(s) Served: Nationwide Contracted Provider: Not Applicable
Description:   Official Web site of US Department of Health and Human Services and the US Justice Department with information about Medicare Fraud, how to prevent it, and how to report it.  

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