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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 five years, these efforts have resulted in more than $25 billion returned to the Medicare Trust Fund from people who attempted to defraud seniors and taxpayers. 

The Affordable Care Act provided additional resources and tools to enable the Centers for Medicare & Medicaid Services (CMS) to expand its efforts to prevent fraud, waste and improper payments.  The same innovative tools are being used to further enhance collaboration with our State and law enforcement partners in detecting and preventing fraud.

By using innovative predictive modeling technology similar to that used by credit card companies, CMS has stopped, prevented or identified $820 million in fraudulent payments over the past three years.  The system identified or prevented $454 million in Calendar Year 2014 alone, a 10 to 1 return on investment.

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.
• 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.
• 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

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