Fraud, waste and abuse

Fraud happens when someone commits a dishonest act on purpose to benefit themselves. Or it may benefit someone it isn’t meant for. 

Examples of fraud can include billing for:

• Items and services a provider didn’t provide

• Items or services a provider didn’t fully document or that weren’t medically necessary

Waste happens when someone gets benefits or services (for themselves or others) that are not meant for them or they don’t need. Some examples of waste include:

• Going to an emergency room if you know it’s not an emergency

• Getting medicine or services you don’t need

Abuse happens when someone’s actions:

• Result in needless costs to Medicare

• Don’t match accepted and sound money, business, or medical practices

• Result in costs or in reimbursement for services that aren’t medically necessary 

• Result in costs that don’t meet professionally recognized standards for health care

It may be abuse if a provider:

• Misuses codes on a claim

• Charges too much for services or supplies

• Bills for services that weren’t medically necessary 

Con artists may try to steal your identity and commit Medicare fraud. They may try to get your Medicare Number or personal info to do this. Remember:

• No one from Medicare will contact you for your Medicare Number or other personal info. Not unless you’ve given them permission in advance. 

• No one from Mercy Care Advantage will contact you to ask for your Medicare Number or other personal info either.

Here’s how you can help protect yourself and Medicare:

• Protect your Medicare Number (on your card) and your Social Security number (on your Social Security card). Treat your Medicare card like it's a credit card. Protect your Mercy Care Advantage ID card.

• Remember that nothing is ever "free." Don't accept offers of money or gifts for free health care.

• Ask questions and learn about your Medicare and Mercy Care Advantage plan coverage.