What YOU Can Do to Out-Hustle Health Care Hustlers

On paper, 2009 was a difficult year for this patient. Her Medicare statements for that year show charges for a full leg prosthesis, parts to replace her leg with mechanical pieces from hip to foot. The total cost of the prosthetic to Medicare? $11,835.

Cost of healthcare
Lilli Day | Photodisc | Getty Images
Cost of healthcare

There’s only one problem: The patient has both her legs. The Medicare invoice for $11,835 was the work of alleged fraudsters, charging for superfluous prosthetics to cash in on Medicare’s taxpayer dollars.

Of all government programs, Medicare is particularly vulnerable to fraud.

“It's fairly easy to get into the Medicare program. It's an honor system. Medicare processes about 5 million claims a day,” said Tom O’Donnell, special agent in charge of the inspector general’s New York regional office.

Here are some tips for you to join the fight against health care hustlers.

Always read your Medicare statement.

The patient, who spoke to CNBC on the condition that she be identified only as Isabel, said she discovered the Medicare fraud by religiously poring over her Medicare statements.

“Every citizen should report whenever they uncover fraud because it’s very important. Every citizen has their responsibility of reporting something that is wrong,” Isabel said.

The first line of defense against Medicare fraudsters is to examine your Medicare statement and make sure you are receiving the care that Medicare is being charged for. If you’re unsure of a procedure that’s been billed for, you should first ask your provider to explain the charges, since honest mistakes aren’t uncommon.

“The coding aspect of the fee-for-service system is certainly something that we think lends itself … to honest mistakes and errors, because it can be pretty complicated,” said Peter Budetti, deputy administrator for program integrity with the U.S. Department of Health and Human Services.

If after you speak to your provider you still suspect fraud, call 1-800-HHS-TIPS.

Research your doctor BEFORE your appointment.

It’s important to remember that while most doctors are there to help, not all health care providers are good actors.

“Probably 90 percent of the providers out there do provide legitimate great services to the elderly and the poor. And that's great,” O’Donnell said. “But it's also very easy to infiltrate and defraud the Medicare system.”

With that in mind, do your due diligence: Ask your general practitioner for referrals to specialists covered by the Medicare program and look up provider ratings on the Internet on such sites as healthgrades.com, where patients can rate their experiences with doctors. Some states even provide free counseling for Medicare beneficiaries: California, for instance, has a program called Health Insurance Counseling and Advocacy Program (HICAP), sponsored by the California Department of Aging. The program allows beneficiaries to meet with a health care advocates to discuss their Medicare needs.

Treat your Medicare number like your credit card number.

Don’t give it out to just anyone. Once a fraudster has your Medicare number, they can bill Medicare for services not rendered. According to federal officials, common schemes to get beneficiary numbers include “health surveys,” where beneficiaries are asked for their Medicare information over the phone. Other common schemes offer groceries or services in exchange for Medicare information. Bottom line: Protect your Medicare beneficiary number like your social security number or credit card.

For more resources and to find out whom to contact if you’ve been a victim of Medicare fraud, visit the below links:

Medicare.gov: Fraud and abuse overview
Medicare.gov: Understanding claims