The National Consumer Protection Technical Resource Center: The Center of Service & Information for SMPs

Health Care Fraud

Medicare Abuse

Here are examples of Medicare abuse:

  • Excessive charges for services or supplies
  • Routinely submitting duplicate claims
  • Improper billing practices such as:
    • Exceeding the limiting charge
    • Billing Medicare at a higher fee schedule rate than for non-Medicare patients
    • Routinely submitting bills to Medicare when Medicare is not the beneficiary’s primary insurer
    • Collecting more than 20 percent coinsurance or the deductible on claims filed with Medicare
  • Breach of the Medicare participation or assignment agreements
  • Claims for services that are not medically necessary
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