Report Fraud


Fraud Prevention

Fraud Costs Top $85 Billion a Year

Report Suspected Fraud: 1-800-336-4522 (or 410-998-5480)

Health insurance fraud has many forms, but collectively it is costing upwards of $85 billion a year, according to the US General Accounting Office. 

Common types of fraud include:

Providers  Members
  • Billing for services that were offered for "free"
  • Billing for services that weren't provided
  • "Upcoding" - charging for a more complex or expensive service than was actually provided
  • Billing for a covered service when the service actually provided wasn't covered
  • Using a member ID card that doesn't belong to them
  • Doctor shopping - visiting several doctors to obtain multiple prescriptions (often for controlled substances)

 

As Medi-CareFirst members and providers, please help us fight fraud.

Preventing Fraud

Protect your Medicare card just like you would protect a credit card!

Review your Explanation of Benefits (EOB) for:

  • Services that you did not receive
  • Incorrect providers or dates of service
  • Prescriptions that were never picked up
  • Medications that are not yours
  • You received the generic but the brand was billed
  • Your plan did not pay for a covered prescription or service you received

Count your pills. The number of pills inside the bottle should be the same as the quantity listed on the label. An isolated occurrence of missing pills indicates a mistake but repeated instances of missing pills might indicate a type of fraud called “short counting,” where a pharmacy bills an insurance company for more pills than were actually dispensed.

Avoid a provider who says an item or service is not usually covered, but they “know how to bill your plan” to get it paid.

Sales Agents & Brokers:

  • Cannot charge a fee to enroll a person in a plan
  • Cannot ask for payment in person, over the phone or over the internet. The plan must send a bill. A member can arrange for monthly withdrawals, but they must call their plan or respond to a mailed payment request from the plan to do this.
  • Sales people cannot come to your house uninvited.
  • Sales people cannot call you if you are on the Federal Trade Commission’s Do Not Call list. (Call 1-888-382-1222 or visit www.donotcall.gov on the web for more information.)

Do not give your Medicare Number to anyone over the phone or in person unless you initiated the contact and know to whom you are talking.

Reporting Fraud

You can report suspected fraud using this online form.

You can also contact our fraud hotline at 410-998-5480 or toll-free at 1-800-336-4522. Phone calls can remain anonymous.
Quick Links
Drug Recalls