How You Can Help Detect and Prevent Fraud

Fraud takes many shapes. Recipients can help uncover and stop wrongful billing practices. One way to help stop waste, abuse and fraud is to keep a record of your medical treatment.


Write down:

• The date you received medical care
• Where the service took place
• What services were provided to you
• The names of who provided the services
• What tests or additional services were ordered by the providers


You should be suspicious if the provider tells you that:

• The test is free; he only needs your insurance number for his records
• They know how to get your insurance to pay for it
• The more tests they provide the cheaper they are
• The equipment or service is free; it won't cost you anything
• Advertise "free" consultations in exchange for your insurance information
• Use telemarketing and door-to-door selling as marketing tools.


To help prevent fraud, report your suspicions. When you receive an Explanation of Benefits or a payment notice from Medicare or Medicaid, review it for errors. The payment notices show what your insurance was billed, what was paid and what you owe. Make sure you were not billed for health care services or medical supplies and equipment you did not receive.




Waste, Abuse and Fraud

  • Definitions of Waste, Abuse and Fraud

  • How to Identify Provider Fraud

  • How to Identify Recipient Fraud

Last Updated: 12/08/2007

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