Fraud Prevention Toolkit

CMS Fraud Prevention Initiative

CMS Fraud Prevention Initiative

The federal government has made important strides in reducing fraud, waste and improper payments across the government. The Affordable Care Act provided additional resources and tools to enable the Centers for Medicare & Medicaid Services (CMS) to expand its efforts to prevent fraud, waste and improper payments. The same innovative tools are being used to further enhance collaboration with our State and law enforcement partners in detecting and preventing fraud.

Using tools provided under the ACA, CMS has used a multifaceted approach, ranging from provider screening to the use of predictive modeling technology similar to that used by credit card companies that has saved nearly $60 billion during 2013-15. This equates to an average savings of $12.40 for each dollar spent on these program integrity efforts.

HOSPICE FRAUD PREVENTION

People with Medicare should beware of scammers offering older Americans in-home perks, like free cooking, cleaning and home health services, while they are unknowingly being signed up for hospice services. The scammers then unlawfully bill Medicare for these services in your name. Criminals are using every avenue they can to sign people up including door-to-door visits, false advertising, phone, text and email. Hospice care is for people who are terminally ill and only the patient and doctor can make this serious decision about end-of-life care. 

Use this toolkit to help prevent hospice fraud. This toolkit includes social media posts and a drop-in article to help educate beneficiaries and their loved ones on how to protect themselves against Medicare Hospice fraud. 

Hospice Fraud Outreach Toolkit (PDF)

Guard Your Card Campaign

The CMS “Guard Your Card” campaign tells people how they can protect themselves against fraud by:

• Never giving out their Medicare or Social Security Number to anyone except those you know should have it.
• Reporting any suspicious activities like being asked over the phone for their Medicare/Social Security number or banking information. Medicare will NEVER call you uninvited for this information.
• By checking their billing statements and reporting suspicious charges. Using a calendar to track doctor’s appointments and services helps quickly spot possible fraud and billing mistakes. Check claims early by logging into mymedicare.gov.

Please report suspicious activities by calling 1-800-MEDICARE (1-800-633-4227).