Preventing Medicare fraud

The Centers for Medicare and Medicaid Services (CMS) defines fraud as “the intentional deception or misrepresentation that the individual knows to be false or does not believe to be true,” and that is made “knowing that the deception could result in some unauthorized benefit to himself or herself or some other person.

Some common examples of fraud are: billing for services/products not provided to beneficiaries, prescribing or providing excessive or unnecessary tests and services, and routinely waiving patient cost sharings, etc. The SMP Resource Center has produced a tip sheet warning about the most common Medicare fraud schemes which can be found at https://smpresource.org/medicare-fraud/.

When you get a chance, please educate your patients to review their healthcare utilizations periodically by reviewing their Medicare statements to detect fraud. See https://smpresource.org/you-can-help/read-your-medicare-statements/ for how to review the statements.