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A few examples:
A recent Government Accounting Office report states employers failed remitting to the IRS $2 billion of Medicare taxes withheld from employees in 2006.
A Dept. of Health and Human Services Strike Force initiative uncovered fraudulent claims totaling $258 million in one Florida district during a three month period.
Recently, four people pleaded guilty in West Virginia, scamming $10 million billing Medicaid for special mattresses when the applicants didn't qualify.
Some common provider fraud:
-- "Upcoding" billing (charging for a more expensive procedure than performed.)
-- Suppliers paying kickbacks to doctors prescribing overpriced equipment.
-- Billing for tests not needed or provided.
-- Double billing.
While some providers scam, some scammers pretend to be providers: recruiting people to sign paperwork for cash, stealing Medicare numbers, "selling" the same equipment multiple times. Many of these operators stay in business briefly, only to set up shop again under another name.
Consumers can help by protecting their Medicare information and checking Explanation of Benefits carefully. If you know your provider, contact them with any questions before assuming fraud. Mistakes happen, especially with all that paperwork. However, you can probably skip that step if charged for multiple prostheses when able-bodied.
Medicare recipients can report fraud through the Dept. of Health and Human Services Inspector General. Or check your State Attorney General's office. Both may offer rewards.


