How to Get Money Back If You Are a Victim of Medicare Fraud

Fight Medical Fraud How to Get Money Back If You Are a Victim of Medicare Fraud

How to Get Money Back If You Are a Victim of Medicare Fraud

Medicare, a federal health insurance program, is available to individuals aged 65 and older or some people with disabilities or End-Stage Renal Disease. If you or a loved one receive Medicare, you know how it can help pay for hospital or skilled nursing facilities, doctors' services, medical supplies, or prescription medication, among other coverage. However, health care fraud is an unfortunate reality that many people face, so it is essential to be vigilant against Medicare fraud. If you have questions or concerns about Medicare fraud, this guide from DoNotPay is for you. 

Medicare Fraud and Abuse

Medicare fraud and abuse take many forms and are committed by many people and entities. 

What Is Medicare Fraud and Abuse? 

Medicare defines fraud and abuse as a company or individual purposely providing false or incorrect information to Medicare or its beneficiaries to obtain unauthorized payments or benefits.

Examples of Medicare Fraud and Abuse 

There are many types of Medicare fraud and abuse, such as 

  • An individual commits identity theft and steals your Medicare information, and submits claims in your name
  • Your provider charges Medicare for services/supplies that you never received (i.e., charging you for medical equipment you did not receive)
  • Your provider bills Medicare more than once for a service or supplies
  • Your health care provider engages in upcoding - this means they bill for services or procedures that are more expensive than you received.

How to Report Medicare Fraud 

If you suspect Medicare billing fraud, it is imperative to report it immediately.

Medicare OfficeReporting Medicare fraud & abuse
Original Medicare
  • 1-800-MEDICARE (1-800-633-4227) or

Medicare Advantage Plan or Medicare drug plan

  • 1-800-MEDICARE (1-800-633-4227) or
  • The Investigations Medicare Drug Integrity Contractor (I-MEDIC) at 1-877-7SAFERX (1-877-772-3379) or
  • by mail: Qlarant, 28464 Marlboro Avenue, Easton, MD 21601, Attn: I-MEDIC

How to Protect Yourself From Medicare Fraud 

The best way to protect yourself from Medicare/medical fraud is to be proactive. It may feel tedious and suspicious to always be on alert, but you must be persistent in protecting yourself and the integrity of the healthcare system. As a patient or medical advocate for a loved one on Medicare, there are several things you can do to fight against Medicare fraud.

  1. Ask questions and remain active in the health care process. Before receiving any services, you should ask why they are needed, how much they cost, and other pertinent questions. You can keep notes to refer back to later.
  2. Examine all paperwork thoroughly. It is important to carefully read any paperwork or claims before filling out or signing.
  3. Compare everything. Take note of receipts, bills you receive, and your Medicare Explanation of Benefits (EOB). Compare them to your personal notes from appointments. By doing this, you can ensure that the dates and services are correct. You will also more readily catch errors or fraud.
  4. If you notice any discrepancies, contact your health care provider. If it is a mistake, they should quickly correct it. If they are engaging in upcoding or unbundling, or another type of health care fraud, they may be less willing to talk with you or fix the issue, and you will need to escalate the situation immediately.
  5. Notify the appropriate agencies as soon as you notice or suspect fraud. You can use the above phone numbers or other listed contact methods to notify Medicare of fraud and the FBI. They can walk you through the appropriate steps to protect you and can conduct their own investigations.

How to Fight Upcoding and Medicare Fraud With DoNotPay

At DoNotPay, we understand that fighting medical fraud can feel intimidating and overwhelming. However, DoNotPay has a simple solution that allows us to write a demand letter for CPT code and bill correction and fight on your side. And if the issue is not resolved by your doctor or health care provider, DoNotPay’s Sue Now product can also help you sue in small claims court.

If you want to find the correct CPT code and write a demand letter for bill correction but don't know where to start, Just follow these simple steps: 

  1. Search Fight Medical Fraud on DoNotPay. 
  2. Tell us the date of your visit, what you were treated for, and where you were treated. 
  3. Let us know what CPT code your visit was filed under. If you don't know, we'll generate a letter for you to send to your physician to request the code. 
  4. Choose the correct CPT code or let us know if you want us to find it for you. 
  5. And that's it! DoNotPay will automatically find the correct CPT code for your visit if you don't know it and then generate a demand letter on your behalf to send to your physician for a bill correction. 

How Else Can DoNotPay Help?

Not only does DoNotPay help you fight Medicare fraud, we can help you work through many issues and problems, including, but not limited to

Sign up today and DoNotPay will help you find the correct CPT code and demand medical bill corrections!

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