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Spotting fraud as a beneficiary

On Behalf of | Sep 27, 2017 | Medicare / Medicaid Fraud

As a beneficiary of Medicare or Medicaid, you use these entitlements to pay for important medical bills or gain access to necessary prescriptions. Protecting the future of these programs remains a top social priority for many, but fraud continues to threaten resources. According to the Coalition Against Insurance Fraud, more than 2,500 people have been charged with Medicare fraud in the past decade, totaling nearly $8 billion in false claims.

Spotting fraud

Misuse of funds can threaten both the viability and credibility of Medicare and Medicaid, and even you as an individual beneficiary can play a role in preventing fraud. A crime against these programs can come in many different forms.

The cases that draw the most attention usually involve millions of dollars and an elaborate scheme. In August, a pharmacist in Manhattan was charged with fraud after allegedly claiming more than $11 million from Medicaid for refills of expensive HIV drugs.

Here are three ways you as a beneficiary can spot potential fraud:

1. Incorrect dates

The first sign of fraud could include receiving a statement that lists incorrect dates in which you received services or used benefits. According to, you should keep a record of what you did and when you did it, and compare these records to what you receive in an invoice.

2. Unknown claims

Medicare is designed with different parts that cover a particular set of services. Medicaid also has a broad range of services in which it covers. You probably know which services will be covered when you go to see the doctor and will expect to see them on your invoice. However, if you are billed for services in which you do not recognize or did not receive, this could be a sign that something is wrong.

3. Unknown providers

The government keeps a list of providers who are allowed to bill Medicare and Medicaid for services. Providers not on the list may be barred from offering services due to compliance issues or past issues with care.

What should I do if something is wrong?

It is important to remember that just because there is an error in your statement that doesn’t automatically mean fraud is being committed. People make mistakes, and the government recognizes the difference between an innocent typo and intentional fraud.

If you think something is wrong, you can contact your provider. From there, you can speak with an attorney who can provide resources for reporting fraud, help you investigate a claim and defend you from potential consequences.