Medicare fraud is responsible for billions of dollars in losses to the federal government every year, which can drive up healthcare costs for everyone. The federal government estimates that $100 billion a year is wasted on fraudulent claims, and that may be just scratching the surface of the fraud taking place in the Medicare program, because hard data is hard to come by.
“We don’t know [how much fraud there is]. Federal technology is so antiquated that the anti-fraud experts I’ve talked to said they have no idea how high the fraud can actually be,” said Rich Daly, senior editor for the Healthcare Financial Management Association.
Medicare fraud – as well as fraud against private insurers – takes the shape of claims for services not rendered or equipment that was never provided to a patient. The National Association of Accountable Care Organizations (ACOs) identified ten medical supply companies that collectively charged Medicare over $3 billion for catheters that cost less than $10 each.
The easiest and most productive way to prevent fraud is to read explanation of benefits documents, looking for items or services that were not provided, Daly said. Suspicious charges can be reported to federal and state watchdog groups or your state attorney general. You can reach the Medicare program’s hotline at Medicare.gov or by calling 1-800-633-4227 (1-800-MEDICARE).