FAQs About Medicare Fraud

National Government Services, Inc. most Frequently Asked Questions about Medicare fraud are listed below. We hope they will help to answer some of your questions.

Question: What types of common situations should be referred to the Fraud and Abuse Department?

Answer: Some instances when the Fraud and Abuse Department should be contacted are: When a beneficiary is billed for covered services, but Medicare has not been billed; When a provider is billing for services that have not been rendered; When someone other than the correct beneficiary is using a Medicare card; and When a provider is giving or receiving any kind of payment for referring patients for Medicare-covered services.

Question: What are common situations that should not be referred to the Fraud and Abuse Department?

Answer: Issues that deal with the quality of care a beneficiary receives are most often addressed by the state survey agency (e.g., Wisconsin Department of Quality & Control).

Question: What type of evidence does the Fraud and Abuse Department need to pursue a case?

Answer: A complaint should clearly describe the fraudulent or abusive activity. In addition, it should contain as much detail as possible in order to help our investigators. Any letters from a provider or notes on conversations with a provider are always helpful. Any other documentation that supports the complaint should be included.