Recognizing Medicare Fraud

Quite often an individual may suspect that fraudulent or abusive activity is occurring. The following items will help you determine if your concerns should be addressed with the Medicare contractor (e.g. NGS, Inc) or a law enforcement agency:

• Billing to Medicare for services that have not been rendered
• Healthcare providers offering to waive Medicare co-insurance and/or deductibles
• Receiving or paying bribes, rebates or kickbacks for Medicare business or referrals
• Falsely representing the type of service performed
• Requiring a deposit as a condition of admission or continued care
• Duplicate billing (billing more than one insurer and/or beneficiary)
• Billing Medicare for costs that are attributable to non-program activities, other enterprises or personal expenses of the provider
• Deliberately providing or receiving benefits on the Medicare account of another individual
• An individual who claims to be from Medicare or another branch of the Federal government and tries to sell you something
• Continued reporting of non-allowable cost items on cost reports
• Including costs of non-covered services, supplies or equipment in allowable cost centers
• Misrepresenting the diagnosis to justify payment
• Unbundling or "exploding" charges
• Falsifying certificates of medical necessity, plans of treatment, and medical records to justify payment

If you are not sure if your concern is really fraud or abuse, feel free to report it - the agency you report it to will determine if there is a problem. Please see How to Report Medicare Fraud at this page.