Health Care Fraud

SMPs Help You Prevent, Detect, and Report

SMP projects use media, community events, outreach events, and other means to teach beneficiaries how to identify and prevent Medicare, Medicaid, and other health care fraud. SMPs help beneficiaries resolve issues and sometimes refer complaints to state and national fraud control and consumer protection entities such as the HHS Office of Inspector General (OIG), Centers for Medicare & Medicaid Services (CMS), Federal Trade Commission, state attorneys general, local law enforcement, state departments of insurance, and others.

Year of Elder Abuse Prevention

Every year an estimated 2.1 million older Americans are victims of elder abuse, neglect, or exploitation. And that’s only what's reported. Experts believe the number could be five times that. The U.S. Administration on Aging (AoA), an agency of the Administration for Community Living (ACL), is sponsoring the Year of Elder Abuse Prevention (YEAP) to encourage national, state, and local organizations to protect seniors and raise awareness about this critical issue.

You can help identify, prevent, and respond to this hidden problem. Click here for a page with a pledge, toolkit, outreach guide, fact sheets, logo, poster, templates, web banners, and social media tools. You can take a stand against elder abuse this year.

The Office of Inspector General

Common Scams and Protecting Yourself

The task of the Office of Inspector General (OIG) is to make sure criminals and fraudsters do not steal your Medicare and Medicaid funds. For information from the OIG about the nature of health care fraud, descriptions of common scams, and how to protect yourself, select from the following:

• Medicare Fraud Schemes  
• Medicaid Fraud Schemes
• State Enforcement Actions

Fraud and Abuse Laws that Apply to Physicians

• Read a summary of the five most important federal fraud and abuse laws that apply to physicians from the OIG publication A Roadmap for New Physicians: Avoiding Medicare and Medicaid Fraud and Abuse: Click here.
• Materials for teaching physicians. Includes links to a booklet, PowerPoint, speaker notes and a narration of the speaker notes.

The Federal Trade Commission (FTC)

Medical Discount Plan Warning Signs

According to the Federal Trade Commission (FTC), what sounds like affordable health insurance may be a medical discount plan instead. Medical discount plans can be a way for some people to save money on their health care costs, but discount plans aren’t health insurance. Some medical discount plans provide legitimate discounts; others take peoples’ money and offer very little in return. Many plans don’t include local providers or give you outdated lists of names and facilities. Some offers are just plain scams. To learn more, click here.

News

• CMS Fraud Prevention System Stopped Millions in Potentially Fraudulent Payments 
• Why Are Older Adults Victims of Fraud?
• Affordable Care Act Scam
• Fight Against health care fraud recovers $4.1B
• Traveling MSN Makes the Rounds
• Beware: Medical Fraud
• Medical Identity Theft Can Harm You

For More Information

• HHS: Stop Medicare Fraud. The U.S. Department of Health & Human Services and U.S. Department of Justice offer information and resources on an initiative, HEAT, that is designed to stop Medicare and Medicaid fraud. 
• Incentive Reward Program. You may be eligible for a reward through the Centers for Medicare and Medicaid Services (formerly known as the Health Care Financing Administration) if your report of Medicare fraud results in a recovery of funds to the Medicare Trust Fund.   
• Kaiser Website with Health Policy Analyses. A leader in health policy and communications, the Kaiser Family Foundation is a nonprofit, private operating foundation focusing on the major health care issues facing the United States as well as the U.S. role in global health policy.
• Medicare Payment Advisory Commission. The Medicare Payment Advisory Commission (MedPAC) is an independent Congressional agency established by the Balanced Budget Act of 1997 (P.L. 105-33) to advise the U.S. Congress on issues affecting the Medicare program.
• Who Cares offers reliable sources of information on a variety of health topics, including Medicare fraud, medical ID theft, generic drugs, and assisted living.