The Nebraska SMP is a special project of the Nebraska Long Term Care Ombudsman Program, Nebraska Health and Human Service System. It is composed of staff and volunteers and is supported in part by a grant form the Administration on Aging.
The goal of the Nebraska SMP is to help individuals identify and report possible Medicare or Medicaid fraud, error or waste and to provide tips on how consumers can protect themselves from healthcare scams.
The Cost of Fraud
Estimates of annual losses due to healthcare fraud range from 5 to 10 percent of all healthcare expenses, which adds up to $80 and $160 billion dollars per year. The U.S. Government Accountability Office (GAO) estimates that $1 out of every $10 spent on public insurance programs is lost to fraud. In addition to the impact on public and private insurance programs, the most recent figure produced by the Federal Trade Commission (FTC) estimates that consumers themselves lose more than $10 billion to healthcare fraud, each year.
Beyond economic injuries, healthcare fraud poses serious threats to personal health. When fraud includes touting unapproved products on the Internet as “cures” for cancer and providing consumers with unnecessary or improper medical equipment or treatment, healthcare fraud is personal and affects us all.
What Can I Do ?
Although the majority of healthcare providers are honest, fraud can and does occur, even in Nebraska. If you have questions about the accuracy of your healthcare charges, contact your healthcare provider (e.g. physician, hospital, medical equipment vendor). If you are not satisfied with the response you receive or suspect healthcare fraud, contact the Nebraska SMP.
Some Examples of Possible Health Care Fraud
- Altering claims to receive a higher payment amount.
- Billing twice for the same service or item.
- Billing for medically unnecessary services or items.
- Billing for services or items not provided.
- Misrepresenting the diagnosis to justify payment.
- Continuing to bill for services no longer medically necessary.
- Billing for rental equipment after date of return.
- Ordering unnecessary lab tests.
- Using another person’s Medicare card to obtain medical care.
- Billing group services as individual services for each patient.
How To Protect Yourself From Fraud and Waste
- Subscribe to SMP Briefs, the Nebraska SMP Program newsletter
- Protect your Medicare or Medicaid card as you would your credit cards.
- Never allow anyone to convince you to contact your physician requesting a service that you do not need.
- Be cautious of “free” offers that require your Medicare or Medicaid number.
- Never accept medical supplies or equipment from a door-to-door salesman.
- Never accept an offer of free medical equipment.
- Always review your Medicare Summary Notice to ensure that it properly reflects the services that you received.
- Always keep a record of your health care appointments and the services you received and compare them to your Medicare Summary Notice.
- Never sign a blank form.
- Always get a receipt for rented medical equipment that you return.
- View the Nebraska SMP's Consumer Tip Sheet on Prescriptiion Drug Scams.
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