Fraud, Waste and Abuse

Committing fraud or abuse is against the law. Medicare fraud wastes a lot of money each year and results in higher health care costs and taxes for everyone. There are con artists who may try to get your Medicare Number or personal information so they can steal your identity and commit Medicare fraud. It is important to remember that Medicare, or someone representing Medicare, will never contact you for your Medicare Number or other personal information unless you’ve given them permission in advance.

Mercy Care Advantage staff will never contact you to ask for your Medicare Number or other personal information.

Fraud means any deliberate and dishonest act committed with the knowledge that it could result in an unauthorized benefit to the person committing the act or someone else who is not entitled to the benefit. Examples of fraud include the following:

  • Billing for items and services that have not been provided;
  • Billing for services or items that have not been properly documented or that are not medically necessary

Abuse can mean that providers take actions resulting in needless costs to Medicare. These are practices that are inconsistent with accepted sound fiscal, business, or medical practices, and result in an unnecessary cost or in reimbursement for services that are not medically necessary or that fail to meet professionally recognized standards for health care. Examples of abuse include the following:

  • Misusing codes on a claim;
  • Charging excessively for services or supplies; and
  • Billing for services that were not medically necessary

You can help protect yourself and Medicare against fraud by taking the following actions:

  • Protect your Medicare Number (on your Medicare card) and your Social Security Number (on your Social Security card). Treat your Medicare card like it's a credit card. Protect your Mercy Care Advantage ID Card.
  • Remember that nothing is ever "free." Don't accept offers of money or gifts for free medical care.
  • Ask questions and educate yourself about your Medicare and Mercy Care Advantage plan coverage. You have a right to know everything about your medical care and why it is medically necessary. Keep track of your doctor's appointments and what tests or X-rays you get.
  • Always check your pills before you leave the pharmacy to be sure you got the correct medication, including whether it's a brand or generic and the full amount. If you don’t get your full prescription, report the problem to the pharmacist.

If you think a person, member or provider is misusing the program, please let us know by contacting the Mercy Care Fraud Hotline: 1‑800‑810‑6544.

You can learn more about Medicare related fraud, at The reporting fraud and abuse section of the website has helpful information and tips to help you better understand how to prevent and spot suspected fraud and abuse. You can report suspected Medicare fraud in any of these ways:

  • 1-800-MEDICARE (1-800-633-4227); (TTY users can call 1-877-486-2048), 24 hours a day, 7 days a week
  • Report it online to the Office of the Inspector General
  • Call the Office of the Inspector General at 1‑800‑HHS‑TIPS (1‑800‑447‑8477). TTY: 1‑800‑377‑4950

* Required Fields

Fraud and Abuse Reporting Form

Optional information: You don’t need to give us your name or contact information. But if you do, we’ll keep it confidential. You can also choose to give us just your contact information and not your name.

If you choose not to give your contact information, our review will be only about the information you’re reporting. It’s important that you give us as much information as you can. It will help us do a complete and correct investigation.

Last Updated: 12/20/2019