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What is Medicare fraud?

The federal Medicare program provides benefits to patients and health care providers in Tennessee by making medical care more affordable and accessible. However, some criminals target this government program when they are planning health care fraud schemes. When Medicare fraud occurs, there may be several consequences to providers and patients. Understanding the warning signs may help you recognize and report suspicious activity to the proper authorities.

There are several possible types of health care fraud that the Centers for Medicare and Medicaid Services attempt to identify and stop. According to CMS, most fraud starts with submitting false claims for medical services. When Medicare approves the claims, it processes payments to the criminals. This means the federal government essentially pays for services that never happened. Sometimes individuals commit Medicare fraud, and sometimes criminals are part of a large organization or institution. Other examples of this kind of fraud include billing Medicare for unattended appointments, unnecessary medical tests and redundant supplies. Criminals may also falsify medical records.

As a Medicare participant, there are several actions you may take to help in the fight against fraud. Keeping detailed records is one of the most important steps. Whenever you receive treatment under your Medicare coverage, you may want to keep note of the date, the services you received and the billed amounts. When you get your statements from Medicare, you may compare the data to your own records to make sure everything matches. If you notice differences between the statement from your doctor's office and the Medicare data, you may contact your provider, the Medicare program and/or the Inspector General's office.

This general information on Medicare fraud is intended to educate and should not be interpreted as legal advice.

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Murfreesboro Office
302 North Spring Street
Murfreesboro, TN 37130

Toll Free: 800-673-1947
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