Medicare Fraud, Waste, and Abuse come from a series of laws enacted by The Social Security Act, The United States Criminal Code, The False Claims Act (FCA), The Anti-Kickback Statute (AKS), and The Physician Self-Referral Law (Stark Law). The laws protect all parties involved in Medicare and Medicaid. Penalties can include as much as $100,000 in fines, imprisonment, and extraction from all government health care programs.
Those who commit Medicare fraud probably think they’re helping themselves, but in the end they’re raising costs and creating a cycle of mistrust among carriers, agents, and beneficiaries.
Medicare fraud happens when a carrier, agent, or client adjusts data to fall in their financial favor. As an agent, it is important that you not only be careful with your own actions but also alert your clients of the penalties for any of the following:
Abuse surrounds unnecessary costs or fees, and it occurs often among the underinformed. Some examples are:
To help fight Medicare fraud, waste, and abuse report any suspicious activity to 1-800-HHS-TIPS (1-800-447-8477). You can also describe the incident in up to ten pages and email it to HHSTips@oig.hhs.gov.