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Medicare Fraud and You

Medicare and Medicaid are viewed as easy fraud targets by a few bad health care providers.  While most doctors and health providers are honest, one or two percent see these multi-billion dollar programs as easy targets to obtain payment they aren't entitled to.

Medicare and Medicaid fraud costs you money.  It increases the amounts you must pay in coinsurance, increase taxpayer costs, raises the price of Medigap coverage, increases the Medicare premium you pay, and helps prevent the addition of new Medicare services such as prescription drug coverage.

Medicare and Medicaid depend on you to tell them about fraud. They pay bills submitted on your behalf-if you don't tell them you didn't get the service billed, or they are billing for a more expensive service than they provided, they won't know they shouldn't have paid the bill.

People on Medicare should view their monthly Medicare Summary Notice. It says what health providers submitted bills for services to you, when the service was provided, and the amount paid by Medicare. If you didn't see that provider, didn't see the provider on the date specified, or the charge seems too high for what was done, call the doctor or provider and ask them for an explanation. Most of the time, there will be a logical explanation or a simple error that can be corrected.  Simple errors aren't to be confused with fraud!

If you aren't satisfied with the explanation, call the Colorado Division of Insurance at 303/894-2268.  They can review the bill, talk to the companies that pay Medicare bills, and see if there is a problem. 

Also be suspicious in these circumstances:

  • You're told the test is free, but they want your Medicare number.

  • A provider says "they know how to get Medicare to pay for it."

  • Suppliers that bill Medicare for services in a nursing home.

  • Phone calls or door-to-door selling of health services.

  • Companies that offer free medical equipment.



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