Fraud Prevention Toolkit

CMS Fraud Prevention Initiative

The federal government has made important strides in reducing fraud, waste and improper payments across the government. Over the last two years, the Centers for Medicare & Medicaid Services (CMS) has implemented powerful new anti-fraud tools provided by Congress and has used large-scale, innovative improvements to our program integrity strategy to shift beyond a “pay and chase” approach by focusing new attention on preventing fraud. Simultaneously, CMS is using the same innovative tools to further enhance our collaboration with our State and law enforcement partners in detecting and preventing fraud.

Significant progress in the fight against health care fraud has resulted in the federal government's recovery of a record $4.2 billion in 2012 from people who attempted to defraud seniors and taxpayers. The Affordable Care Act provides additional resources and tools to enable  CMS to expand efforts to prevent and fight fraud, waste and abuse.  CMS is also using a predictive analytic technology called the Fraud Prevention System to identify the highest risk claims for fraud, waste and abuse in real time that has stopped, prevented or identified $115 million in payments, resulting in an estimated $3 for every $1 spent in its very first year.  CMS is also making it easier for seniors to join in the fight against fraud.  In March 2012, CMS redesigned Medicare Summary Notices and made them available online to make it easier to spot fraud or errors.  The redesigned notices will be mailed to people with Original Medicare in 2013.

Help Prevent Fraud Campaign

The CMS “Help Prevent Fraud”  campaign tells people how they can protect themselves against fraud by never giving out their Medicare or Social Security Number to anyone except their authorized provider and reporting any 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 also help protect Medicare from fraud by checking their billing statements and reporting suspicious charges.  Using a calendar to track doctor’s appointments and services helps quickly spot possible fraud and billing mistakes.  Check claims early by logging into mymedicare.gov or calling 1-800-MEDICARE and help spot and report fraud sooner!  See the “Downloads” section for the “MSN Changes” to see how CMS made it easier to spot fraud and understand claims billed to Medicare.

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