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Medicare Fraud Reporting

Taxonomy Code: FN-1700.3350-550

Programs that provide a hotline, website or other mechanisms that persons with Medicare and the public at large can use to report health care providers or beneficiaries who make false statements or representations which result in an unauthorized payment by the Medicare program to themselves or another. Also included are organizations that accept and investigate reports about fraudulent entities that misrepresent themselves as approved Medicare Part D Prescription Drug Plans; approved plans that use aggressive marketing tactics, discriminate against a beneficiary (e.g., prevent them from signing up for a plan based on their age, health status, race or income), entice beneficiaries to enroll in a more costly plan than they require, or erroneously charge beneficiaries for medication provided under the plan they have selected; or pharmacies that provide a different drug than the one prescribed by the physician. Examples of Medicare fraud include incorrect reporting of diagnoses or procedures to maximize payments; billing for services, medical supplies, equipment or medications not provided; misrepresentation of the dates and descriptions of services or medications provided, the identity of the recipient or the individual furnishing services; and billing for noncovered or nonchargeable services as covered items. Also included are programs that provide consumer education, counseling and assistance with the objective of helping people identify instances of fraud.

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