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Fraud and Abuse
Fraud is a major concern in the healthcare industry that costs tens of billions of dollars each year and harms patients and providers. We rely on providers and patients as a critical frontline resource for help in combatting fraud crimes and unnecessary costs.
We need your help to make a difference in reducing fraud and abuse. Anyone can remain anonymous when reporting healthcare fraud and abuse.
Information for Providers
Healthcare fraud and abuse can include:
- Billing for services the patient never received.
- Filing claims for unnecessary procedures.
- Filing a claim for a more expensive procedure than the one performed.
- Duplicate submission of a claim for the same service.
- Billing for durable medical equipment not ordered or provided.
- Billing for a covered service when the service provided wasn't covered.
To report possible healthcare fraud and abuse:
- Complete our Report Suspected Fraud and Abuse form.
- Call our toll-free hotline at 1-800-824-4391.
- CMS’ website offers numerous resources that can be found using the search term “fraud”
- CMS fraud prevention training materials
- Office of Inspector General fraud and abuse laws
Information Related to Patients
Examples of healthcare fraud and abuse can include:
- Using an expired or fraudulent identification card to get medical services or medications.
- Lending an ID card to someone who isn't entitled to it.
- Adding someone who isn't eligible for coverage to a contract.
- Not removing someone from a policy when that person is no longer eligible.
- Forging or altering bills.
- Misrepresenting physical conditions or medical history in order to obtain multiple prescriptions.