Implementing a compliance program to identify and prevent healthcare fraud Developing a strong compliance program is key to preventing healthcare fraud and abuse activities.
However, in the normal course of medical business, unpleasant things can happen, like billing mistakes and, most alarmingly, Medicare fraud and abuse. Medicare billing errors Billing errors are often innocent mistakes not intended to defraud the Medicare system.
For example, a doctor may use the wrong medical code on a claim submitted to Medicare. Even though the service description sounds right, the wrong code could change how much you pay out of pocket.
This one-time, innocent mistake is not a case of Medicare fraud. In order to avoid billing errors, be sure to pay close attention to the payment notice you receive from Medicare or your insurance company.
If you suspect a mistake, immediately talk to your doctor or a staff member about it.
Medicare fraud involves doctors or beneficiaries abusing the Medicare system for their own personal gain. You can help detect Medicare billing fraud by carefully reviewing your payment notice.
This is the notice you get whenever a doctor or health care provider bills Medicare or your insurance company for a health care product or service. The notice identifies the product or service and lists the total amount billed, the amount Medicare or your insurance company paid to the provider, and the amount you owe.
Also, beware of providers who: Someone besides you uses your Medicare card to receive products or services. Never give or lend your Medicare card to anyone except your health-care providers. It is as serious an offense as Medicare fraud.
Medicare abuse, like Medicare fraud, is illegal and punishable to the full extent of the law.
Report Medicare fraud and abuse If you suspect Medicare fraud or abuse, you should report it right away. To report Medicare fraud or abuse, you can do any of the following: The TTY number is You can also send up to 10 pages describing the incident to HHSTips oig. Fax your report up to 10 pages to BoxWashington, DC Florida residents only can call or email floridamedicarefraud hp.
Call to speak with a licensed insurance agent now.Our Proven Approach to Detecting and Preventing Health Care Fraud, Waste and Abuse The first step of our prevention and detection services involves the assignment of a manager, senior investigator, data analyst or statistician, and subject matter expert to each project.
AVOIDING FRAUD, WASTE, AND ABUSE 2 Preventing Fraud, Waste, and Abuse When discussing health care fraud, waste, and abuse, it is important to define the terms.
“Fraud” is defined as intentional deception. Medicare FRAUD & ABUSE is a serious problem that needs your attention Here are ways to avoid fraudulent activities: Designate a compliance officer or contact and implement compliance and practice standards Conduct appropriate training and education while developing open lines of.
Prevent fraud: protect your Medicare and Social Security Numbers, check your statements, ask questions about bills. AVOIDING FRAUD, WASTE, AND ABUSE 2 Preventing Fraud, Waste, and Abuse When discussing health care fraud, waste, and abuse, it is important to define the terms. “Fraud” is defined as intentional deception.
“Waste” is defined as over-utilization. Management of each TBR institution is responsible for maintaining a work environment that promotes ethical and honest behavior. Additionally, it is the responsibility of management of each TBR institution to establish and implement internal control systems and procedures to prevent and detect irregularities, including fraud, waste and abuse.
To prevent an organization from participating in healthcare fraud and abuse activities, providers should understand key healthcare fraud laws, implement a compliance program, and improve medical billing and business operations processes. Learn about examples of Medicare fraud, like getting billed for services or equipment you never got. Avoiding Fraud; Avoiding Fraud. Believe It or Not: Social Security Number Misuse Cases. Posted by: The Communications Division. DATE: What Is Fraud, Waste, or Abuse? Submit a Report; About This Blog. The Beyond the Numbers blog is a platform for you to engage with the OIG. Read about what we do and why we do it.