What Is the Monetary Reward for Reporting Medicare Fraud?

Fight Medical Fraud What Is the Monetary Reward for Reporting Medicare Fraud?

Is There a Reward for Reporting Medicare Fraud?

In the US, the Centers for Medicare & Medicaid Services (CMS) pay a reward for reporting Medicare fraud worth more than $100. The total reward amount is up to CMS, which doesn't publish any guide to respective amounts. CMS states the reward amount will be based on the money saved when the Medicare fraud is discovered and proved, so a more significant case of fraud will eventually lead to a bigger reward.

If you suspect a healthcare provider is committing Medicare billing fraud, you should report it. You can do this easily with the help of DoNotPay, or you can do it by yourself. We'll explore both ways in this article. First, let's look at some signs that may prove your healthcare provider is taking advantage of Medicare and taxpayers.

Types of Medicare Fraud

Medicare fraud occurs when funds are unfairly taken from the Medicare program. This fraud is a waste of taxpayer dollars and hurts the program as a whole, including everyone who receives Medicare benefits. 

There are dozens of ways a provider can hustle Medicare for funds they don't deserve. But they can usually be divided into two types of fraud:

  1. Medical billing fraud, which includes upcoding and unbundling
  2. Services fraud, which happens when providers charge Medicare for services you don't need or don't receive

In a nutshell:

  1. Upcoding occurs when a healthcare provider bills Medicare for more expensive procedures than they provide to you. For instance, if you go to the emergency room and have five X-rays taken, but the hospital bills Medicare for 12 X-rays, that's upcoding.
  2. Upbundling occurs when providers charge Medicare for a bundle of services, even if you only use one. For instance, if that hospital charges you for a three-day stay in the hospital, including all the meals, but you only stayed one day, that's upbundling.

Other types of health care fraud exist, too. Sometimes hospitals bill Medicare for services you don't even need or didn't receive. In other cases, staff or even total strangers may use our benefits number to get services.

This is closely linked with identity theft, so you must read all your statements of benefits that you receive from Medicare, and compare them to your experience. Remember, reporting Medicare fraud does more than earning you a reward. You'll save money for the program, save money for taxpayers, and help ensure that your neighbors always deal with honest healthcare providers.

How to Prevent Medicare Fraud

Never share your Medicare benefits number with anyone other than your spouse, healthcare providers, healthcare proxy, and power of attorney. If someone calls you on the phone requesting your benefits number, don't share it. Medicare will never contact you and ask for your number. Don't let anyone handle your purse or wallet unless you genuinely trust them.

And finally, read every piece of mail Medicare sends you regarding your benefits. Compare the services you receive with the services for which Medicare pays.

How to Report Medicare Fraud by Yourself: The Medicare Fraud Hotline

Medicare offers a few resources. Check out the table below.

Type of FraudHow to Report it
If you suspect provider fraud against original Medicare (other than Part C)Call 1-800-MEDICARE / 1-800-633-4227
If you suspect fraud against a Part C provider (these are private insurers)Contact The Investigations Medicare Drug Integrity Contractor (I-MEDIC) at 1-877-7SAFERX (1-877-772-3379), or by mail at:

Qlarant

28464 Marlboro Avenue

Easton, MD 21601

Attn: I-MEDIC

Gather Your Documents Before Contacting Medicare to Report Fraud

You'll need some paperwork handy before you make the call. You will need:

  • Your name and Medicare Number
  • The name of the provider you're reporting and their address, if you have it
  • The service or item you're questioning and when you supposedly got it
  • The amount Medicare paid

Remember, the more information you can provide to Medicare, the more likely your chances are of getting that well-deserved reward. DoNotPay is always the fastest and easiest way to get a reward for reporting Medicare fraud, so don't hesitate to try. And there are more ways mature individuals can use the app.

How to Report Medicare Fraud With DoNotPay

Healthcare providers can sometimes make billing mistakes. If you want to find the correct CPT code and write a demand letter for bill correction, or wish to report Medicare fraud but don't know where to start, DoNotPay has you covered in 5 easy 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.

     

It's that easy. And it only takes a few moments.

What Else Can DoNotPay Do?

Aside from reporting fraud, DoNotPay can also help you address the following:

Join DoNotPay today to demand medical bill corrections instantly!

Want your issue solved now?