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Health Line
9 hours ago
- Health
- Health Line
How to Identify and Report Medicare Fraud
Medicare fraud is when a person knowingly submits false information or misuses the Medicare system to achieve personal financial gain or to receive benefits for which they are ineligible. Medicare has numerous official channels for reporting suspected fraud. While estimates vary, the Senior Medicare Patrol reports that Medicare losses due to fraud could be as high as $60 billion annually. What's clear is that Medicare fraud and abuse are pervasive, put significant stress on the system, and have the ability to affect the care that older adults receive. Medicare fraud can be perpetrated by various people and organizations, including healthcare providers, such as doctors, clinics, or hospitals, as well as criminal groups and individuals. In this article, we'll discuss what Medicare fraud is, how to identify it, and where to report it. Common types of Medicare fraud Medicare fraud can take many forms and can affect both beneficiaries and providers. Common types of Medicare fraud include: Medical identity theft: This can take many forms. It could involve using another person's Medicare number to obtain healthcare services or benefits or using a physician's identifier to fill prescriptions. Billing for unnecessary services: Under Medicare regulations, many procedures only receive coverage if they're considered medically necessary. If a provider intentionally bills for unnecessary procedures, it is a form of fraud. Kickbacks: Kickbacks are when a provider receives some form of compensation in exchange for referrals or utilization of services. An example would be a doctor who receives personal payment from a lab facility for referring patients. Billing for services never rendered: This is when a provider bills Medicare for services or procedures it never actually administered. It may involve falsifying documentation to create the appearance of authenticity. Upcoding and unbundling of services: Upcoding involves billing for services at a higher complexity than those actually rendered. Unbundling involves submitting bills in a staggered fashion to maximize payment when Medicare requires that those bills be submitted together to reduce costs. Vigilance is important in matters related to Medicare and billing. Understanding what to look for can help you identify fraud in practice. As a consumer and Medicare beneficiary, be sure to regularly check your Medicare claims and keep an eye out for irregularities. Look for: unfamiliar charges on your Medicare summary notice line items for services you didn't receive bills from unfamiliar providers If you have regular contact with a healthcare professional, facility, or other provider, you may notice trends that could signal potential fraud. These include: unusual billing patterns geographic anomalies suspicious documentation patient complaints How to report Medicare fraud If you suspect fraud may be occurring with a given provider, it's important to notify the Centers for Medicare & Medicaid Services (CMS). Reporting suspected fraud, waste, or abuse in Medicare programs is key to protecting both the integrity of the Medicare system and the individuals it serves. You can do this in various ways: Contact Medicare by phone at 800-MEDICARE (800-633-4227). Submit a complaint online with the Office of Inspector General of the Department of Health and Human Services (HSS-OIG). Contact the HSS-OIG by phone at 800-HHS-TIPS (800-447-8477). Individuals with a private Medicare plan, such as a Medicare Advantage (Part C) or Part D plan, can also reach out to the Investigations Medicare Drug Integrity Contractor (I-MEDIC) with fraud complaints. You can reach I-MEDIC by phone at 877-772-3379. Before filing a complaint, it's important to collect all relevant documentation to back up your claim. This includes: your Medicare number the subject of your complaint, including information that can identify them the service in question and the date of receipt the cost of the service Summary Fraud and abuse cost Medicare billions of dollars each year. Reporting Medicare fraud is important for protecting individuals and maintaining the integrity of the Medicare system. Always guard your Medicare card, number, and other personal medical information. Additionally, review your Medicare summary notices routinely for irregularities that suggest inappropriate billing. If you think you were billed incorrectly, consider contacting Medicare for clarification. While errors happen, and not all errors are due to fraud, it's best to be safe and report your concerns. The information on this website may assist you in making personal decisions about insurance, but it is not intended to provide advice regarding the purchase or use of any insurance or insurance products. Healthline Media does not transact the business of insurance in any manner and is not licensed as an insurance company or producer in any U.S. jurisdiction. Healthline Media does not recommend or endorse any third parties that may transact the business of insurance.
Forbes
18 hours ago
- Business
- Forbes
What DOGE Can Do For Social Security
The Social Security Administration sends millions of "clawback letters" each year. If the Department of Government Efficiency (DOGE) can stop our Social Security system from sending checks to dead people, that would be a plus. Yet a far more important task is to stop the system from overpaying people who are very much alive. Last year the Social Security Administration admitted it had identified 2 million beneficiaries who have been overpaid and sent them 'clawback' letters, demanding the government's money back. Some of these claims go back several decades, and they can amount to hundreds of thousands of dollars. As revealed in a recent episode of 60 Minutes, in one case the agency sent a clawback letter to a 32-year-old man, living on Social Security and disabled by cerebral palsy. The agency claimed that 21 years earlier, when he was 11 years old, his mother was overpaid $4,902 on his behalf—and the government wants its money back! In another case the agency demanded more than $300,000 from a disabled woman living on her Social Security benefits. In a third case, the agency demanded to be reimbursed for an overpayment that was 45 years old. In all these cases, the agency admits that these mistakes were made by the government, not by the beneficiaries. Further, if its demands are not met, Social Security threatens to stop sending the beneficiaries as much as half of their monthly benefit checks. Aside from the human tragedies clawback letters create for the people who receive them, there are three practical reasons why taxpayers should care. First, our government has wasted millions of dollars by sending out checks for the wrong amounts—money that in most cases will never be recovered. Second, when the government demands its money back it is often going after people who had no idea they were overpaid and who are living on a fixed income. Forcing a retiree to sell his house or cash out his IRA to pay a surprise bill from the government seems especially cruel in many cases. That's inconsistent with Social Security's role as a safety net. Third, virtually no one on Social Security knows whether their check is the 'right' amount. That means every beneficiary is at risk of receiving a clawback letter, and that creates a level of insecurity that is the opposite of the purpose of the Social Security system. Although the dimensions are much smaller, Social Security acknowledges it also has a history of sending checks to people who are dead. We don't have to rely on Donald Trump or Elon Musk for verification. The agency's Inspector General recently discovered as many as 217 dead Oregonians were receiving checks. In one case, a dead beneficiary received checks for 15 years. While the agency overpays some people, it underpays others. According to the Office of Inspector General, more than 13,000 widows and widowers collectively have lost $130 million in Social Security benefits because of mistakes in claiming spousal benefits. Married couples also lose thousands of dollars because they make mistakes in claiming spousal benefits. More often than not, these mistakes are made because of bad advice from Social Security personnel. Note: If people make a mistake in claiming benefits, they are generally not allowed to correct it—even if the mistake was not their fault. Yet, as noted, if Social Security makes the mistake, it demands its money back. Why is Social Security making so many mistakes? For two reasons. First, the system is enormously complex. It has 2728 rules and hundreds of thousands of pages explaining the rules, governing just 13 basic benefits. Second, it relies on human resources rather than computer programs to make decisions. The most important revelation from DOGE so far is not the finding of large amounts of fraud, waste and abuse. It is the finding that so many agencies (including the IRS and the FAA) are using computer programming language that the private sector abandoned decades ago. The main language used to run Social Security's core systems, for example, is a 60-year-old program called COBOL (Common Business-Oriented Language). There aren't that many people alive who are still able to program in COBOL. That Social Security does not have a computer program that can tell its own employees as well as beneficiaries the right amount of their monthly benefit is truly amazing. What is even more surprising is that the private sector not only has a very accurate Social Security benefit calculator, it also tells viewers how to claim benefits in a way that maximizes their lifetime income. The private calculator, developed by Boston University economist Laurence Kotlikoff, is available to everyone for $49. Yet think of how much misery could be avoided if the government created something similar – or simply leased the private program -- and made it available to everyone for free. It was Prof. Kotliioff who first discovered the problem of clawback letters. He created an online portal where people could submit their personal horror stories, many of which appear in a book he co-authored with financial advice columnist Terry Savage. Going forward, there are three changes that merit urgent attention. First, we need to bring Social Security's computer systems into the 21st century. There is no reason why the country's most important retirement system isn't using the same software available to private financial firms. Second, there should be a reliable online calculator that allows Social Security personnel to avoid mistakes and prospective beneficiaries to make informed judgments about claiming benefits. Third, there should be a one-year statute of limitations on Social Security clawback claims while we are waiting to get an accurate computer system in place. DOGE can help with the first two of these reforms. Congress is probably needed for the third.
Washington Post
2 days ago
- Business
- Washington Post
Here's how to bolster Social Security
The June 19 news article 'Social Security could be insolvent by 2033' added to the fearmongering that's unfortunately ever-present in the Social Security conversation. Today, Social Security's trust funds have a combined reserve of $2.7 trillion, and spending has exceeded revenue since 2021. Yes, if nothing changes, in 2033, Social Security benefits will automatically be slashed by 23 percent. Though that is a meaningful reduction, it represents neither bankruptcy nor insolvency.
News24
4 days ago
- Business
- News24
Treasury's Sassa corruption prevention steps come ‘at the cost of humanity'
Parliamentarians have been inundated with frantic messages from social grant beneficiaries who cannot verify their grant status – a new requirement imposed by National Treasury to root out corruption. The corruption-busting steps imposed on the SA Social Security Agency (Sassa) have a negative impact on many grant recipients, most of whom are elderly citizens living in rural areas. Of significant concern is the in-person verification process of recipients. Chairperson of the Portfolio Committee on Social Development Bridget Masango said the Treasury has attached strict new conditions to the allocation of funds to Sassa. 'National Treasury has attached strict new conditions to the allocation of funds to Sassa. These include quarterly reporting on suspended, cancelled or reviewed grants, income verification, including database cross-checks with the SA Revenue Services, National Student Financial Aid Scheme, the Unemployment Insurance Fund and Home Affairs as well as biometric authentication for beneficiaries flagged as suspicious. 'Treasury argues these steps are essential to combat fraud and ensure value for money and failure to comply by Sassa may result in grant funding being withheld, a deeply concerning possibility for millions who rely on this support,' Masango said. She said the concern is not because they oppose fraud prevention, but because the current implementation is causing delays, confusion and deep distress among beneficiaries. Masango said: 'The requirement for in-person verification is disproportionately impacting rural communities and elderly caregivers who simply cannot afford to travel. Transport costs can reach up to R150 or more, an unaffordable amount for some beneficiaries. 'We are being flooded with WhatsApp messages, SMSs, and emails from desperate individuals who are unable to verify themselves. People are being excluded from the system and all of this in the name of saving money. Sassa has defended the verification process as necessary,' Masango said. Furthermore, Masango said, Sassa argues the requirements prevent fraud and ensures 'accurate targeting'. 'They have reminded beneficiaries of their duty to report changes in financial circumstances. That may be valid, but it must be balanced with accessibility and fairness. To ensure accountability, Sassa will now submit quarterly reports directly to the parliamentary committee, in addition to National Treasury. This will allow Parliament to play a proactive oversight role, especially after lessons learned during the card replacement crisis,' she said. According to Masango, no cost-saving measure should come at the expense of basic dignity or leave the poor out in the cold. 'The committee acknowledges the R1.6 billion increase in the 2025/26 grant allocation, intended to fund above-inflation increases. We also note Sassa's intensifying efforts to fight fraud, such as the rollout of biometric systems, a new tender to assist with identity verification and digital upgrades, including office WiFi, self-service kiosks, and action against fake Sassa websites. We are of the view, National Treasury must balance fiscal prudence with social justice,' Masango said. READ | Second income trouble: SASSA identifies 210 000 possible 'double-dippers' She also said the social grant system is not just a financial mechanism, but a lifeline for many poor families. 'Let us not forget the people behind the statistics, the grandmother raising orphans, the young person living with a disability, the unemployed breadwinner trying to survive. We must protect the integrity of the system, yes, but never at the cost of humanity,' she said. Meanwhile, Masango also expressed deep concern at South Africa's drug and substance abuse problem. 'Our children are drinking liquor. Our schools are not safe. Our rural communities are forgotten. Institutions such as the Central Drug Authority (CDA), meant to fight this crisis are underfunded and unsupported. 'It is thus gravely concerning to the committee that the CDA remains dependent on the Department of Social Development for finances, undermining its ability to operate independently across government,' she said.
CNET
4 days ago
- General
- CNET
Social Security Disability Insurance: The Final Payment for June Is on the Way
June's SSDI checks are headed to beneficiaries soon. Here's this month's payment schedule. CNET Social Security Disability Insurance recipients who haven't been paid yet can expect their payments soon, as the last round of payments will head out in a couple of days. What week of the month you get paid is dependent on the day of the month you were born, how long you've received SSDI or whether you receive Supplemental Security Income, too. We'll explain. The Social Security Administration sends monthly payments to people with disabilities that prevent or limit their ability to work. Depending on their individual situation, others may qualify and can apply for SSDI as well. We'll break down the full SSDI payment schedule for the month of June and how your payment date is calculated so you'll know exactly when you can expect your check. For more, here's what you can do if your last payment never arrived, and here's the Supplemental Security Income payment schedule. If you've had SSDI since May 1997 or earlier, or also receive SSI If you started getting SSDI before May 1997, you'd usually receive your payment on the third day of every month. Note that this isn't always the case, like when the third day falls on a weekend or holiday. For 2025, this will happen in August, so you can expect to receive your payment during that month one to two days earlier. If you also receive Supplemental Security Income, you'll fall into this category. You'll receive your SSDI payment on the third of every month and your SSI payment on the typical day, the first of the month. For everyone else, payments are birth date-dependent If you began receiving SSDI after May 1997 and don't also receive SSI, then your payment date is determined by the day of the month you were born. Payments are typically paid out on the second, third and fourth Wednesday of the month. Which Wednesday you get your check breaks down like this: Birthdate between Social Security check date 1st and 10th of the month Second Wednesday of the month 11th and 20th of the month Third Wednesday of the month 21st and 31st of the month Fourth Wednesday of the month Here's when you'll get your SSDI payment in June Here's when your SSDI payment should arrive this month: If you've received Social Security before May 1997 June 3 If your birthday falls between day 1 and 10 of the month June 11 If your birthday falls between day 11 and 20 of the month June 18 If your birthday falls between day 21 and 31 of the month June 25 How does 2025 COLA affect my payment? The COLA for 2025 introduced a 2.5% increase in monthly benefit checks, but exactly how much of an increase will depend on several factors. Any monthly income, how long you've received benefits and what type of benefit you receive can result in a different payment increase. Recipients should have received their COLA notice sometime in December with specific details on their case. A COLA of 2.5% will add about $48 to the average benefits check. For more, don't miss four ways you could lose your Social Security benefits and how to apply for SSI.
