Health care fraud has been estimated by the FBI to cost the government $80 billion dollars a year, largely in the Medicare and Medicaid sector. It is no question that Medicare fraud is an issue that Medicare officials are constantly trying to fight.

Just this February, federal officers took down the largest Medicare fraud operation to date: a home healthcare scam based in Dallas, Texas, estimated to have cost the Medicare program over $375 million dollars.

ABC News also covered the Medicare fraud bust. You can read their report here.

According to the ABC report, Medicare requires doctors to “certify” that services are legitimate and eligible for Medicare reimbursement. Federal officers accused Dr. Jacques Roy, the alleged leader of the scheme, of selling his certification to nearly 500 Texas home health care companies, who were then able to fraudulently bill Medicare for services not provided.  The operation produced thousands of false Medicare claims by recruiting individuals, including the homeless, for home health care and other unnecessary services.

The Medicare program has also taking strides towards combating Medicare fraud by launching a fraud-detecting computer system last summer, as reported by the Associated Press.

What Can You Do to Help?

Fighting Medicare fraud is not only limited to government officials and high-tech computer software; Medicare beneficiaries can also be proactive in the fight against Medicare fraud.

Medicare recommends the following “3 easy steps” to fight fraud:

  1. Review your Medicare claims to make sure they are accurate.  Check them early — the sooner you see and report errors, the sooner we can stop fraud.
  2. Learn how to protect your personal information.
  3. Be on the lookout for suspicious activity.

The US Depart of Health and Human Services reportedly saved taxpayers $4.1 billion dollars last year thanks to tips for individuals reporting suspicious Medicare activity.

In order to gain more public support in the fight against Medicare fraud, Medicare has recently enforced format changes to its billing forms, according to Kaiser Health News/Washington Post. These new forms, feature a larger font size and plain English explanations of medical services to help beneficiaries not only better understand their bills, but also better detect false charges and Medicare fraud. The paper version of these bills, mailed to 36 million beneficiaries every three months, will be implemented early next year.

In addition, the new statements will contain a promise for a reward up to $1,000 for any viable tip leading to Medicare fraud exposure. The reward is not a new incentive, but has not been advertised on the statements before.

Anyone can report suspected Medicare fraud in the following ways:

  • Phone: Call the Office of Inspector General at 1-800-HHS-TIPS, TTY: 1-800-377-4950.
  • Fax: Fax a letter to 1-800-223-8164 (requires a formal cover letter or a complaint submission form, available in PDF or DOCX versions).
  • Online: Fill out a Medicare Fraud report form online here.
  • Mail:Send a letter to the Office of Inspector General at the following address:Office of Inspector General
    Department of Health & Human Services
    ATTN: HOTLINE
    PO Box 23489
    Washington, DC 20026