Medicare Compliance
MeridianComplete Members
Each year, healthcare fraud costs taxpayers billions of dollars. It drives up the cost of health care and puts a burden on taxpayers and the healthcare system. Healthcare fraud can take on many forms, from small infractions to multi-million dollar schemes. It can also occur anywhere, from small rural towns to major metropolitan cities.
How to Report Fraud
If you believe you have seen any of these activities, you can contact us immediately at 1-855-323-4578 (TTY:711), Monday - Sunday from 8 a.m. to 8 p.m. We will conduct a thorough investigation and work with State and Federal government agencies to make sure your rights and services are protected to the fullest extent. You may also visit our Fraud Waste & Abuse webpage.
Examples of Fraud
At MeridianCare, we are committed to doing our part to stop healthcare fraud. You can also do your part in fighting against healthcare fraud by protecting yourself against fraudulent claims and practices.
Here are some examples of activities you should look for:
- Does your Explanation of Benefits (EOB) show a charge that you did not receive?
- Does your provider bill for services not provided?
- Is your provider rendering unnecessary services?
- Is your provider prescribing a higher quantity than is medically necessary for a condition?
- Did a sales agent call you or show up at your residence without your permission to market a Medicare Advantage product or service?
- Did you get a phone call from an unknown caller offering low cost or free medical services? Did the caller ask for your personal information, such as your Social Security number, Medicare number or date of birth?
- Do you know someone who changed or forged a prescription?
- Do you know a provider who primarily writes for narcotics or controlled substances?
- Do you know someone who visits multiple doctors to get the same prescription?
- Do you know someone who fills a prescription and then sells the medication?
- Are medications you picked up expired, fake or diluted?
- Did you pharmacy give you generics when your prescription requires that a brand be dispensed?
- Does your pharmacist provide less than the prescribed quantity and bill for the full amount?
- Did you incur a claim for prescriptions that you never picked up?
Resources
There are many resources available to help you stay informed of fraudulent activities and give you tips on how to protect yourself from them. This is just a short list of some of these resources.
- Report Fraud & Abuse: This government website provides information on Medicare fraud, including examples and how to detect and report them.
- Identity Theft: This government website provides information on identity theft and how to recover from it.
- 4R (PDF): This government document provides tips on how to spot Medicare fraud.
- Protecting Yourself & Medicare from Fraud (PDF): This government document provides tips on how to spot Medicare fraud.
- Quick Facts about Medicare Plans & Protecting Your Personal Information (PDF): This government document provides information on inappropriate Medicare health plan activities.
- US Department of Justice: This government website provides news and updates on national health care fraud.
- Office of Inspector General: This government website provides news and updates on national health care fraud.