Fraud Prevention Toolkit

CMS Fraud Prevention Initiative

Health care fraud drives up costs for everyone in the health care system and endangers Medicare's ability to serve future generations. To address this growing problem, the federal government continues to expand efforts to recover improper payments and prevent fraud. Significant progress in the fight against health care fraud has already been made as shown by the federal government's recovery of a record $4 billion last year from people who attempted to defraud seniors and taxpayers. The Affordable Care Act provides additional resources and tools to enable the Centers for Medicare & Medicaid Services (CMS) to expand efforts to prevent and fight fraud, waste and abuse.

Fraud prevention efforts focus on moving CMS beyond its former “pay and chase” recovery operations to a more proactive “prevent and detect” model that will help prevent fraud and abuse before payment is made. A good example is the recent CMS announcement that for the first time, through the use of innovative predictive modeling technology similar to that used by credit card companies, the agency will have the ability to use risk scoring techniques to flag high risk claims and providers for additional review and take action to stop payments and remove providers from the program when necessary.

Help Prevent Fraud Campaign (August 22 – October 1, 2011)

If you help people with Medicare, watch for the CMS “Help Prevent Fraud” Campaign on TV and in newspapers in your area, especially if you live near Los Angeles, Miami or New York.

The campaign tells people how they can protect themselves against fraud by checking their billing statements and reporting suspicious charges. People should also report other suspicious activities, like being asked over the phone for their Medicare/Social Security number or banking information. Medicare will NEVER call for this information.

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