How do I Report Someone For Committing Fraud and Getting Florida Medicare?

Florida residents can report Medicare fraud to a specific hotline

The United States Federal Government established Medicare to help cover the costs of medical expenses for Americans over the age of 65. Medicare fraud occurs when health care providers file false or inflated claims for goods or services never received by patients. National Public Radio estimates that Medicare fraud costs the program $70 billion annually, which results in higher premiums for those enrolled in the program. The Miami Herald reports that Florida leads the nation in many categories of Medicare fraud. In response, Medicare set up a fraud reporting hotline specifically for Florida residents.

Things You'll Need

• Medicare Health Insurance Claim Number
• Medicare Summary Notice

Instructions

1. Inspect each Medicare Summary Notice when you receive it in the mail. These notices itemize every procedure or good, such as blood tests or wheelchairs, billed to your Medicare Health Insurance Claim Number (the number you received when you enrolled in Medicare, which also appears on your Medicare card). Mark any treatment, test, good or procedure that you do not specifically remember receiving.

2. Call the health care provider that billed you for the suspicious item/s. Your Medicare Summary Notice will list the contact information of each health care provider for each item billed to your identification number. Medicare reports that most billing mistakes involve errors on the part of physicians or hospitals and do not constitute Medicare fraud. Ask the health care provider to clarify the billings. If you still suspect fraud, proceed to Step 3.

3. Write down any discrepancies between the procedures or goods you have received and the procedures or goods billed to your Medicare Health Insurance Claim Number. Next to each discrepancy, include the health care provider that billed your account for those items, and the date on which the alleged goods or services were administered. Locate and write down the cost for each suspected fraudulent item and also the reason why you believe that it the health care provider should not have billed it to your Medicare Health Insurance Claim Number (for example, you never ordered or received a wheelchair billed to your account).

4. Report the fraud to the Florida Medicare fraud hotline office. You can email, call or file a written report (see Reference 4 for the contact information). Identify that you are reporting fraud during the first line of the letter or email or during the initial conversation over the phone so that Medicare can immediately direct your claim to the fraud investigative bureau.

Tips & Warnings

• Be suspicious of any health care provider that offers free consultations to anyone enrolled in Medicare.

• Do not reveal your Medicare Health Insurance Claim Number to anyone other than your doctor or member of a health care provider's staff.

References

• NPR: Medicare Fraud Acute in South Florida
• Miami Herald: Magnitude of Medicare fraud in South Florida grows
• Medicare: Medicare Fraud Overview
• Medicare: How to Report Medicare Fraud
• Medicare: Medicare Fraud Detection and Prevention Tips

Resources

• Social Security Online: Medicare FAQ's