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How to Identify and Report Medicare Fraud

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.

The Department of Health – Abu Dhabi and Abbott Unite to Manufacture Pharmaceuticals Locally in Abu Dhabi

Al Bawaba

20-06-2025

Health
Al Bawaba

The Department of Health – Abu Dhabi and Abbott Unite to Manufacture Pharmaceuticals Locally in Abu Dhabi

Department of Health -Abu Dhabi is the regulative body of the Healthcare Sector in the Emirate of Abu Dhabi and ensures excellence in Healthcare for the community by monitoring the health status of the population. DoH defines the strategy for the health system, monitors and analyses the health status of the population and performance of the system. In addition DoH shapes the regulatory framework for the health system, inspects against regulations, enforce standards, and encourages adoption of world – class best practices and performance targets by all healthcare service providers in the Emirate. DoH also drives programs to increase awareness and adoption of healthy living standards among the residents of the Emirate of Abu Dhabi in addition to regulating scope of services, premiums and reimbursement rates of the health system in the Emirate of Abu Dhabi.

The role of consumer health in expanding access to care

Fast Company

18-06-2025

Health
Fast Company

The role of consumer health in expanding access to care

Healthcare is evolving. Once confined to clinics and in-office appointments—healthcare is now in our homes, routines, and daily choices. The shift towards accessible healthcare solutions, like over-the-counter (OTC) medicines, is empowering people to manage their health proactively. With 81% of adults using OTC medicines for minor ailments, this societal change saves physicians many hours each year, reducing the strain on healthcare systems. Despite increasing consumer interest in self-care, critical health categories like pain management, skin cancer, and more remain undertreated, underdiagnosed, and underpenetrated. The self-care revolution Consumers are increasingly investing in their health. In the U.S. alone, a staggering 82% of consumers consider health and wellness a leading priority in their lives, contributing to a $480 billion market. This clear sign shows that more people are actively taking charge of their well-being today to build a healthier future. Yet, accessibility gaps persist. Science and innovation must bridge this gap—not just through new formulations, but through better awareness, education, and application methods. Consumer-focused companies like ours are working to address this. The power of innovation Despite skin cancer diagnoses outnumbering all other cancers in the U.S., only 13.5% of adults wear sunscreen daily. Our research found that 99% of healthcare providers believe better application and aesthetics would boost sunscreen use. In response, our R&D teams at Neutrogena developed a new mineral formula that overcame these top consumer barriers with more UVA protection and less whitening compared to competitors, all while providing a lightweight, invisible finish. Our goal is to improve consumers' willingness to wear sunscreen regularly, protecting their skin and health. While new innovations create a solution to the problem, education is what empowers consumers to pick it up in the aisle. For example, research shows a need for wider education about sun care in schools, so Neutrogena teamed up with Walgreens and the Melanoma Research Foundation to teach students and families the importance of sunscreen use. Programs like this help people understand how to practice preventative care, and its benefits as one of the most powerful tools in reducing health inequities. Where do we go from here? Consumer health companies can make a difference—whether through smarter skincare solutions, new pain relief technologies, or improved application methods. Here are three ways to do that. 1. Accessibility must be a priority, not an afterthought Despite advancements in OTC medicine, inaccessibility remains widespread. According to the World Health Organization, nearly 2 billion people lack reliable access to essential medications, such as acetaminophen in the pain care category. Beyond availability, consumers are also facing unique barriers based on their needs or stage of life. Despite many pain relief options being in pill form, people are often averse to swallowing pills for a variety of reasons ranging from general dislike to fear of choking. To make pain care accessible to more people, this unique need must be front and center in product development. Our Tylenol teams used this information and philosophy to develop products for several life stages, adding powder packs to make it easier for children to swallow, and a topical pain relief formation for those with skin discomfort Accessibility drove the creation to ensure that more people could get the relief they needed in a way that worked for them. 2. Sustainability is front and center Consumers today want products that not only enhance personal health but also minimize environmental impact. The future of consumer health is one where science works smarter, faster, and more sustainably, ensuring the well-being of people and the planet. As part of Kenvue's approach, we developed an internal assessment tool, the Sustainable Innovation Profiler, which helps our product developers select more sustainable ingredients, packaging, and product formats. Integrating this capability into our innovation process should help us meet the rising expectations of consumers, retailers, and regulators, while building a more resilient and sustainable future and driving brand growth. 3. Collaboration is key to expanding everyday care No single company can solve the accessibility crisis alone. Partnerships between brands, healthcare providers, retailers, and policymakers are essential for meaningful impact. We do this by partnering with dermatologists, pediatricians, and public health organizations to identify care gaps and address misinformation. By meeting consumers wherever they are—aisles, pharmacies, doctor's offices, or online—we empower them to take charge of their health.