Preventing Medicare Fraud: How to Prevent Medicare Fraud?

Consumers should be aware of the different types of Medicare fraud that exists, and most importantly how to prevent Medicare fraud. This responsibility actually extends to both patients, as well as employees in private firms who are suspicious that their employer is exploiting the Medicare system for personal financial gain. Through being aware of the different types of Medicare fraud, you can help fight back against the exploitation that not only costs taxpayers their money, but patients their livelihood and health.

Ways to Prevent Medicare Fraud

For an individual consumer, one of the most important steps to prevent Medicare fraud is to keep an eye on Medicare statements. If you notice a charge that has been sent to Medicare that you have no prior awareness of, or did not authorize, you should contact a Medicare representative so that they may conduct an investigation. While often such mistakes are honest, there is always a possibility that your health care provider is tacking on additional charges for services that were never incurred. By reporting this behavior, you are helping defend both the Medicare system, and taxpayer dollars.

Another way to prevent Medicare fraud is for employers to be aware of the techniques utilized by crooked corporations to exploit the system. There have been instances of large corporations billing Medicare for millions of dollars of unnecessary or fraudulent services. Medicare allows people to report fraud anonymously. In this way, you can report surreptitious behavior without placing your job security—or safety—at risk. If you are part of a company that you suspect is creating fraudulent Medicare expenses, you should not hesitate to report it. Crime doesn't pay, and loyalty to a firm that is running a criminal operation will ultimately only hurt you.

On the individual level, you can also prevent Medicare fraud by paying attention to the reputation of private healthcare providers, and carefully choosing who you sign up with. Under the recent Affordable Care act, there are new resources for consumers to monitor the reputations of HMOs, and there are also new incentives that reward the private insurers that meet ethical and quality standards. However, in addition to this, you should still remain vigilant against methods in which a private health care practice may exploit the system.

One way that a crooked health practice may exploit Medicare is by charging you with unnecessary equipment, medications, or even surgical procedures. A technique that you can use to prevent Medicare fraud perpetrated by a misdiagnosis is to have a second health care provider offer an alternative opinion. Although you may feel pressure to accommodate a doctor's particular methodology, it's also important to practice a level of critical thinking, and to listen to your instinct if you feel a diagnosis may have been exaggerated or even falsified.

You should also be careful of a health provider that appears incessantly pushy. If you feel you are being coerced into purchasing unnecessary prescription drug plans, this is also a type of fraud. This may happen through a doctor trying to explain that because of your unique condition, it's absolutely necessary that you must purchase specific drugs only available through a certain provider. Incidentally, this provider would not be covered by Medicare, which means you must pay out of pocket expenses in addition to your Medicare costs.

This type of scam may also manifest through a doctor using a similar tactic to promote a specific HMO. These days, through the Affordable Care act, it's easier to track the reputations of private health providers that are affiliated with Medicare. If a particular Medicare Advantage plan has received a low-star quality rating, you should avoid it regardless of what a doctor may have told you. There are certain HMOs that charge unfair premiums and deductibles—and while this is not illegal by itself, it's illegal for any health care professional to falsify medical information in an attempt to pressure you into joining a specific provider. Most likely, that particular HMO has a dishonest reputation and the only way they can find new clients is through a system of dishonesty and coercion.

Best Way to Prevent Medicare Fraud

So, the best way to prevent Medicare fraud is by remaining vigilant and aware of different scams that exist. And also, through being quick to alert Medicare officials if you suspect there is something unusual happening. While the Affordable Care act has made it more difficult for con-artists to run illegitimate practices or to falsify information, scams will continue to persist throughout the country, and it's up to a combination of the vigilance of both government departments and individuals to minimize the amount of fraud that occurs.

Fortunately, the majority of both private Medicare affiliates, as well as individual health care practices, are committed to preventing fraud. It is only a minority of crooked organizations and individuals who cost taxpayers millions of dollars, and place patients at risk. With any luck, this minority will continue to decrease as harsher legislation passes and as consumers become more aware of the methods to prevent Medicare fraud. If you are seeking additional resources outside of this unofficial article, you can visit for up to date information on how to stop fraud, and to help you make the best decisions that relate to you the health and expenses of you and your family.