Department  of  Health  and  Human  Services 
OFFICE  OF 
INSPECTOR  GENERAL 
BENEFICIARY  AWARENESS  OF 

MEDICARE  FRAUD 

JUNE  GIBBS  BROWN 
Inspector  General 
JANUARY  1998 
OEI-12-97-00440  OFFICE  OF INSPECTOR  GENERAL 
The mission  of the Office  of Inspector  General  (OIG),  as mandated  by Public  Law  95-452,  is to 
protect  the integrity  of the Department  of Health  and Human  Services  programs  as well  as the 
health  and welfare  of beneficiaries  served  by them.  This  statutory  mission  is carried  out through 
a nationwide  program  of audits,  investigations,  inspections,  sanctions,  and fraud  alerts.  The 
Inspector  General  informs  the  Secretary  of program  and management  problems  and recommends 
legislative,  regulatory,  and operational  approaches  to correct  them. 
Office  of Evaluation  and Inspections 
The  Office  of Evaluation  and Inspections  (OEI)  is one of several  components  of the  Office  of 

Inspector  General.  It conducts  short-term  management  and program  evaluations  (called 

inspections)  that  focus  on issues  of concern  to the Department,  the Congress,  and the public.  The 

inspection  reports  provide  findings  and recommendations  on the efficiency,  vulnerability,  and 

effectiveness  of departmental  programs. 

OEIs  Headquarters  Office  prepared  this report  under  the direction  of Debra  Robinson,  Director 

of Policy  Oversight  Division,  and with  the assistance  of staff  from  all Regional  Offices  and 

Headquarters  Divisions.  Principal  OEI staff included: 

Susan  Burbach,  Project  Leader 

Robert  Gibbons 

Mark  Krushat 

Andrew  McLaughlin 

Adrienne  Corpuz 

To obtain  copies  of this report,  please  call OEI Headquarters  at (202)  619-0480. 
Reports  are also  available  on the World  Wide  Web  at our home  page  address: 
http://www.dhhs.gov/progorg/oei  BENEFICIARY  AWARENESS  OF 

MEDICARE  FRAUD 

JUNE  GIBBS  BROWN 
Inspector  General 
JANUARY  1998 
OEI-12-97-00440  PURPOSE 
To assess  Medicare  beneficiaries  current  knowledge  and awareness  of Medicare  fraud  and to 
gather  information  to assist  in planning  the outreach  campaign  advertising  the Office  of Inspector 
General  (OIG)  fraud  hotline. 
BACKGROUND 
In  1996, the  OIG  launched  a new  initiative  called  Outreach.  The primary  goal  of the outreach 
initiative  is to combat  Medicare  fraud,  waste,  and abuse.  The  initiative  involves  three  primary 
activities.  The  first activity  was to create  a more  user-friendly  OIG fraud  hotline  which  was 
implemented  in July  1997.  The  second  major  activity  is to conduct  a nationwide  outreach 
campaign  to educate  beneficiaries  and other  citizens  on Medicare  fraud-what  it is, how  to 
recognize  it, and where  to report  it.  Third,  we have  developed  partnerships  with  other  agencies 
and organizations  also involved  in fighting  Medicare  fraud-the  Health  Care Financing 
Administration  (HCFA),  the Administration  on Aging  (AoA),  and the American  Association  of 
Retired  Persons  (AARP). 
AoA  and AARP  have  related  activities  as part  of the outreach  campaign.  AoA  has received 
funding  for two  separate  grant  programs  designed  as health  care anti-fraud  outreach  programs  for 
older  Americans.  AARP  plans  to craft  a education  campaign  to engage  its members  in the  fight 
against  health  care  fraud. 
To gather  data  for this  study,  we conducted  a telephone  survey  with  329 Medicare  beneficiaries 
out  of a simple  random  sample  of 625. 
FINDINGS 
Knowledge  about Fraud 
More  than  half  of beneficiaries  believe  that Medicare  fraud  is common.  Fifty-three  percent  of 
Medicare  beneficiaries  agree  that Medicare  fraud  is common. 
Beneficiaries  want  to play  a role in stopping  Medicare  fraud.  Medicare  beneficiaries 
overwhelmingly  agree  (94 percent)  with  the statement,  It is my  personal  responsibility  to report 
suspected  cases  of Medicare  fraud. 
Most  beneficiaries  say they read their Explanation  of Medicare  Benefits.  Almost  three  out  of 
four  Medicare  beneficiaries  (74 percent)  say they  always  read their  Explanation  of Medicare 
Benefits  statements  (EOMBs). 
1  However,  most Medicare  beneficiaries  believe  that  recognizing  fraud  is difficult.  Almost  six 
out of ten beneficiaries  (58 percent)  disagree  with  the  statement  Medicare  fraud  is easy  to 
recognize  and  an additional  19 percent  dont  know  if Medicare  fraud  is easy to recognize. 
Further,  most  beneficiaries  say they have not received  information  on Medicare  fraud.  Only 
15 percent  of beneficiaries  say that they  have  received  or looked  for information  on Medicare 
fraud. 
Finally,  beneficiaries  are not aware  of agencies  working  to reduce  Medicare  fraud.  Eighty-
eight  percent  of beneficiaries  say they  are not  aware  of any agencies  that work  to reduce 
Medicare  fraud. 
Encountering  and Reporting  Potential Fraud 
Almost  one in five  beneficiaries  say they have  encountered  potential  Medicare  fraud. 
Beneficiaries  who  were  both  educated  beyond  high  school  and report  that they  were  in fair or 
poor  health  were  much  more  likely  to have  stated  that they  encountered  fraud  than  all other 
beneficiaries. 
Beneficiaries  say they  would  report  suspected  Medicare  fraud,  but many  do not when  actually 
faced  with  a potentially  fraudulent  situation.  Eighty-five  percent  of beneficiaries  say that they 
would  not be reluctant  to report  Medicare  fraud.  However,  of those  surveyed  beneficiaries  who 
said they  have  encountered  potential  fraud,  only  55 percent  reported  it. 
Most  beneficiaries  are not aware  there  is a toll-free  number  to report  Medicare  fraud. 
Eighty-six  percent  of  beneficiaries  do not know  there  is a toll-free  hotline  to report  Medicare 
fraud.  Almost  one-third  (29 percent)  say they  do not know  whom  they  would  contact  if they 
encountered  potential  Medicare  fraud. 
If beneficiaries  knew  more,  they would  be more  likely  to report potential  fraud.  Almost  nine 
out of  10 beneficiaries  (89 percent)  agree  that if they  knew  more  about  Medicare  fraud,  they 
would  be more  likely  to report  it. 
Reaching  Medicare  Beneficiaries through Outreach 
Magazine  readership  is high  among  beneficiaries.  Seventy-two  percent  of beneficiaries  say 
they  read  magazines  regularly.  Over  one-third  read Modern  Maturity,  AARPs  magazine, 
regularly. 
A large  majority  of beneficiaries  regularly  receive  news  through  mainstream  media.  Three 
out of four beneficiaries  say they  regularly  read the newspaper.  Eighty  percent  of beneficiaries 
say they  regularly  watch  national  news  on television  and 77 percent  regularly  watch  local  news. 
This  confirms  the possibility  of using  the mainstream  media  for the outreach  campaign. 
ii  Many  beneficiaries  watch  cable  television  channels  for  news  and entertainment.  Nearly  two-
thirds  (62 percent)  of beneficiaries  say they  watch  at least  one  cable  channel. 
NEXT  STEPS 
We conducted  this  survey  to prepare  for our outreach  campaign  to educate  beneficiaries  on 

Medicare  fraud  and where  to report  it.  We collected  baseline  data on Medicare  beneficiaries 

current  awareness  of Medicare  fraud  and data on the media  preferences  of beneficiaries. 

The  survey  confirms  the need  for a campaign  to educate  beneficiaries.  Beneficiaries  appear  to be 

on the right  track  with  a large  majority  saying  they  already  always  read their  EOMBs.  Because 

of the information  provided  on the EOMB,  reviewing  EOMB  statements  is the best  way  to detect 

billing  errors  and potential  fraud.  However,  the survey  results  suggest  that beneficiaries  may  not 

know  what  to look  for on their  EOMBs.  AARF and AoA  have  ongoing  activities  to address  this. 

AARP  is developing  materials  to educate  beneficiaries  about  how  to spot  irregularities  on their 

EOMBs.  AoA  has  funded  projects  to educate  beneficiaries  how  to read  their  EOMBs.  The 

survey  also  found  that  few beneficiaries  know  of the existence  of a toll-free  Medicare  fraud 

hotline  number.  To address  this,  we are working  with  HCFA  to begin  printing  the phone  number 

for the  OIG  fraud  hotline  on EOMBs  along  with  a message  encouraging  beneficiaries  to report 

suspected  fraud  and abuse. 

As we prepare  for the  launch  of the outreach  campaign  activities,  the outreach  partners  (OIG, 

AoA,  HCFA,  and AARP)  should  keep  in mind  where  beneficiaries  receive  information.  We 

found  that  more  than  half  of beneficiaries  read AARPs  magazine,  Modern  Maturity,  regularly  or 

sometimes.  This  makes  Modern  Maturity  an ideal  publication  in which  to print  stories  and 

information  about  Medicare  fraud.  Further,  because  the mainstream  media  has a large  following, 

newspapers  and national  and local  news  programs  may  be effective  avenues  for certain 

components  of the campaign.  Cable  television,  while  not quite  as popular  as the mainstream 

media,  may  also  effectively  reach  beneficiaries  and other  citizens.  AARF is developing  public 

service  announcements  for broadcast  media. 

We plan  to repeat  this  survey  after the outreach  campaign  has been  underway  for a year  or two. 

This  will  enable  us to measure  the effect  the outreach  activities  have  had  on Medicare 

beneficiaries  awareness  of Medicare  fraud. 

. . . 
111  PAGE 
EXECUTIVE  SUMMARY 
INTRODUCTION  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..l 
FINDINGS  ..............................................................  . . . 4 
NEXT  STEPS  ...........................................................  . . 10 
ENDNOTES  ............................................................  . . 11 
APPENDICES  ...........................................................  . . . . 
A.  Telephone  survey  instrument  .......................................  A-l 
B.  Baseline  statistics  ................................................  . B-l 
C.  Confidence  intervals  for selected  statistics  ............................  . C-l 
D.  Respondent  and non-respondent  analysis  .............................  D-l  INTRODUCTION 
PURPOSE 
To assess  Medicare  beneficiaries  current  knowledge  and awareness  of Medicare  fraud  and to 
gather  information  to assist  in planning  the outreach  campaign  advertising  the Office  of Inspector 
General  (OIG)  fraud  hotline. 
BACKGROUND 
Consumer  Awareness  of Health Care Fraud 
Evidence  suggests  that  although  consumers  believe  that health  care fraud  is rampant,  they  do not 
know  how  they  can assist  in combating  it.  In late  1996, the American  Association  of Retired 
Persons  (AARP)  conducted  a survey  on consumer  awareness  of general  health  care  fraud  and 
abuse.  Overall,  the  survey  found  that consumers  believe  that health  care fraud  is widespread,  and 
18 percent  said that  they  had personally  experienced  health  care fraud.  Consumers  also believe 
that  fraud  in Government  health  care programs  (Medicare  and Medicaid)  is more  widespread 
than  in the private  sector.  Almost  80 percent  of consumers  are not  aware  of any efforts  to reduce 
health  care  fraud.  However,  the vast majority  of survey  respondents  (85 percent)  indicate  that 
they  would  be inclined  to report  suspected  fraud  if they  knew  more  about  it. 
Office of Inspector  General Outreach Initiative 
In  1996, the  OIG  launched  a new  initiative  called  Outreach.  The primary  goal  of the  outreach 

initiative  is to combat  Medicare  fraud,  waste,  and abuse.  Our first activity  was to create  a more 

user-friendly  OIG  fraud  hotline  (the toll-free  number  that people  can call to report  suspected 

fraud  of the programs  of the Department  of Health  and Human  Services).  This  involved 

developing  a simple  menu  system  and having  most  callers  connect  with  a person,  rather  than  a 

recording.  We implemented  the improved  hotline  in July  1997. 

Next,  we plan  to conduct  a nationwide  outreach  campaign  to educate  beneficiaries  and other 

citizens  on Medicare  fraud-what  it is, how  to recognize  it, and where  to report  it.  The 

campaign  will  promote  the OIG hotline  and educate  consumers  about  its appropriate  use.  As a 

first  step,  we developed  partnerships  with  other  agencies  and organizations  also involved  in 

fighting  Medicare  fraud-the  Health  Care Financing  Administration  (HCFA),  the Administration 

on Aging  (AoA),  and AARP.  Through  the assistance  of a marketing  firm  and a number  of focus 

groups,  we are designing  the campaign  and developing  a variety  of campaign  materials, 

including  a logo,  poster,  brochure,  fact sheet,  article  series,  Rolodex  card,  and public  service 

announcements  for print  media. 

1 
 AoA  and AARP  have  related  activities  as part  of the outreach  campaign.  AoA  has received 
funding  for two  separate  grant  programs.  Both  are designed  as health  care anti-fraud  outreach 
programs  for older  Americans.  First,  the Omnibus  Consolidation  Appropriations  Act  of  1997 
(P.L.  104-209)  established  demonstration  grants  to train  retired  professionals  to teach  their  peers 
how  to read  and interpret  their  Explanation  of Medicare  Benefits  (EOMBs)  statements  in order  to 
identify  Medicare  fraud,  waste,  and abuse.  Twelve  grants,  referred  to as Harkin  grants  because 
the  legislation  was  offered  by Senator  Harkin  of Iowa,  were  awarded  by AoA  in June  1997. 
Second,  under  the Health  Insurance  Portability  and Accountability  Act (HIPAA),  AoA  has 
funded  anti-fraud  and abuse  grants  to 15 State  agencies  on aging.  In addition  to funding  outreach 
training  for aging  network  staff,  these  HIPAA  grants  provide  for public  awareness  campaigns. 
AARP  plans  to craft  an education  campaign  to engage  its members  in the  tight  against  health 
care fraud.  AARP  will  develop  a brochure  on health  care fraud  and the importance  of reading 
Medicare  claims  statements.  AARP  will  also develop  a basic  training  kit to train  volunteers  how 
to teach  Medicare  beneficiaries  about  fraud  and reading  Medicare  claims  statements.  Further, 
AARP  will  develop  fact sheets  about  medical  areas particularly  vulnerable  to fraud,  such  as 
home  health,  laboratories,  nursing  homes,  and durable  medical  equipment.  Finally,  AARP  plans 
to develop  public  service  announcements  for print  and broadcast  media. 
We undertook  this  study  to gather  baseline  data on Medicare  beneficiaries  prior  to the  launch  of 
the various  outreach  activities.  We will repeat  this  study  in l-2  years.  This  will  enable  us to 
measure  the  effect  the outreach  activities  have  had on beneficiaries  awareness  of Medicare 
fraud. 
METHODOLOGY 
We conducted  a telephone  survey  of Medicare  beneficiaries.  Specifically,  we selected  a simple 
random  sample  of 625 Medicare  beneficiaries  from  HCFAs  national  claims  history  file.  Of the 
625 beneficiaries,  we were  able to find phone  numbers  for 467.  The  sampled  beneficiaries  had  at 
least  one  claim  submitted  to a Medicare  Part B carrier  during  1996.  We excluded  beneficiaries 
currently  enrolled  in Medicare  managed  care, beneficiaries  enrolled  in managed  care  at some 
point  during  1996,  and deceased  beneficiaries.  We sent personalized  letters  to each  of the 467 
Medicare  beneficiaries  approximately  1 week  before  we fielded  the survey. 
We conducted  interviews  with  329 of the 625 beneficiaries  or their  proxy  for a response  rate of 
53 percent.  Of the  329 interviews,  48 (15 percent)  were  conducted  with  a proxy  who  answered 
the  survey  on behalf  of the beneficiary  when  the beneficiary  was unable  to participate  due to 
illness,  cognitive  impairment,  or a disability  that prevented  participation.  We asked  that  the 
proxy  respondent  be the person  who  handles  the beneficiarys  medical  business.  Most 
commonly,  proxies  were  a spouse  (48 percent),  a child  (19 percent),  or another  family  member 
(25 percent).  In the report,  when  presenting  data about  beneficiaries,  we are referring  to 
beneficiaries  and proxies.  Appendix  D presents  an analysis  of respondents  and non-respondents. 
2 
 We conducted  this  inspection  in accordance  with  the  Quality  Standards  for  Inspections  issued  by 
the Presidents  Council  on Integrity  and Efficiency. 
3 
 KNOWLEDGE  OF FRAUD 
More than half of beneficiaries  believe that Medicare  fraud is common. 
Our survey  results  showed  53 percent  of sampled  Medicare  beneficiaries  agree  that Medicare 
fraud  is common.  Of those,  39 percent  strongly  agree  and  14 percent  slightly  agree. 
Fourteen  percent  disagree  that  fraud  is common.  Interestingly,  almost  one-third  (32 percent) 
dont  know  if fraud  is common. 
Beneficiaries want to play a role in stopping Medicare  fraud. 
While  Medicare  beneficiaries  believe  that Medicare  fraud  is common,  they  also believe  that  they 
have  a part  to play  in stopping  it.  Medicare  beneficiaries  overwhelmingly  agree  (94 percent) 
with  the  statement,  It is my personal  responsibility  to report  suspected  cases  of Medicare  fraud. 
Further,  beneficiaries  believe  it is worth  their  while  to combat  fraud.  Just  17 percent  of 
beneficiaries  agreed  with  the  statement  Its not worth  the time  and effort  for me to report  and 
pursue  suspected  health  care fraud.  Finally,  85 percent  of beneficiaries  said they  would  not be 
reluctant  to report  suspected  fraud. 
Most beneficiaries  say they read their Explanation  of Medicare  Benefits statements 
(EOMBs). 
Almost  three  out of four Medicare  beneficiaries  (74 percent)  say they  always  read  their 
EOMBs.  Some  beneficiaries  (44 percent)  also get help  reading  their  EOMBs,  most  commonly 
from  a spouse  or a child.  Only  11 percent  of beneficiaries  say they  hardly  ever  or never  read 
their  EOMB s.  
Further,  a relationship  exists  between  reading  EOMBs  regularly  and having  knowledge  about 
fraud.  We define  those  having  knowledge  of fraud  as beneficiaries  who  say they  have  either 
received  information  or asked  about  or looked  for information  on Medicare  fraud.2  We found 
that  28 percent  of beneficiaries  who  always  read  their  EOMBs  are knowledgeable  about 
Medicare  fraud  compared  to only  16 percent  of beneficiaries  who  sometimes  read  their 
EOMBs  and only  3 percent  of those  who  hardly  ever  or never  read  their  EOMBs.  Possibly, 
the relationship  occurs  because  beneficiaries  who  are already  knowledgeable  about  fraud  know 
the importance  of reading  their  EOMBs  rather  than  that the beneficiaries  become  knowledgeable 
about  fraud  because  they  read  their  EOMBs. 
4 
 However,  most Medicare  beneficiaries believe that recognizing fraud is difficult. 
The  first  step  to detecting  fraud  is reviewing  ones  EOMB  statements.  Yet, beneficiaries  may 
not know  what  they  should  keep  an eye out for.  Many  do not know  how  to recognize  Medicare 
fraud.  Almost  six out of ten beneficiaries  (58 percent)  disagree  with  the statement  Medicare 
fraud  is easy  to recognize  and an additional  19 percent  dont  know  if Medicare  fraud  is easy 
to recognize. 
Further, most beneficiaries  say they have not received information  on Medicare  fraud. 
Only  15 percent  of beneficiaries  say they  have  received  or looked  for information  on Medicare 
fraud.3  Of those  who  received  information,  3 1 percent  say they  received  information  from 
Medicare  in some  way,  such  as the Medicare  handbook,  EOMBs,  or from  Medicare  carriers  that 
process  Medicare  claims. 
Table I: 
Beneficiaries  receive  information  on Medicare  fraud  from  a variety  of sources4 
Source  of Information 	 ;Percent  of Beneficiaries  Receiving 
i Information  from  Source  (of those  who 
i received  information) 
Medicare  31% 
21% 
............._.........................................................................<............................................................................................... 
Newspaper  or magazines  19% 
...................................................................................................<................................................................................... 
Television  or radio  13% 
Other  source  27% 
Finally, beneficiaries  are not aware of agencies working to reduce Medicare  fraud. 
Beneficiaries  may  not  think  to look  for Medicare  fraud  not only  because  they  do not know  what 
to look  for, but  also because  they  are not  aware  that  government  agencies  are interested  in 
stopping  Medicare  fraud.  Eighty-eight  percent  of beneficiaries  say they  are not  aware  of any 
agencies  that work  to reduce  Medicare  fraud.  This  finding  closely  mirrors  the AAFW survey 
that  found  79 percent  of consumers  were  not  aware  of any efforts  to reduce  health  care fraud. 
5 
 ENCOUNTERING  AND REPORTING  POTENTIAL  FRAUD 
Almost one in five beneficiaries  say they have encountered  potential Medicare  fraud while 
they have been in the Medicare  program. 
In our  survey  of Medicare  beneficiaries,  19 percent  of respondents  report  that  they  have 
encountered  potential  Medicare  fraud. 5 Ten percent  of beneficiaries  have  encountered  a doctor  or 
other  health  care provider  that billed  Medicare  for services  or equipment  they  did not receive. 
Seven  percent  have  encountered  a doctor  or other  health  care provider  that billed  Medicare  for 
the same  services  or equipment  more  than  once. 
We analyzed  a number  of variables  to determine  which  beneficiaries  are more  likely  to encounter 
fraud,  including  income  level,  age, marital  status,  education  level,  and self-reported  health  status. 
Two  factors  appear  to predict  if a beneficiary  will  encounter  fraud-education  level  and  self-
reported  health  status.  Beneficiaries  were  asked  to rate their  health  as either  excellent 
(21 percent),  good  (36 percent),  fair (31 percent),  or poor  (11 percent).  As shown  in Table  2 
below,  beneficiaries  who  were  both  educated  beyond  high  school  and in fair or poor  health  were 
much  more  likely  to reported  encountering  fraud  than  all other  beneficiaries.  This  probably  does 
not  suggest  that having  a higher  educational  level  leads  a person  to be a target  for Medicare 
fraud.  Rather,  this  could  suggest  that having  a higher  educational  level  may  cause  a person  to be 
more  knowledgeable  about  potential  fraud  and abuse  situations. 
Table 2: 

Education  and self-reported  health  status 

affect  whether  a beneficiary  has encountered  potential  Medicare  fraud 

Education  Level  Percent 	 Reporting  Encountering 
Potential  Fraud 
Beyond  High  School 
......... . ..............................  ........ ..... 
High  School  or Less 
Beneficiaries  say they would report suspected Medicare  fraud, but many do not when 
actually faced with a potentially fraudulent situation. 
Eighty-five  percent  of beneficiaries  say that they  would  not be reluctant  to report  Medicare  fraud. 

However,  of those  beneficiaries  who  said they  have  encountered  potential  fraud,  only 

55 percent  reported  it. 

6 
 Most benefidiaries are not aware there is a toll-free number to report Medicare  fraud. 
Eighty-six  percent  of  beneficiaries  do not know  there  is a toll-free  hotline  to report  Medicare 
fraud.  We asked  beneficiaries  whom  they  would  contact  if they  encountered  Medicare  fraud. 
Almost  one-third  (29 percent)  say they  do not know  whom  to contact.  Likewise,  if an EOMB 
showed  that  Medicare  had paid  for services  or products  the beneficiary  did not receive,  21 
percent  of beneficiaries  do not know  whom  to contact. 
Beneficiaries  have  different  ideas  about  where  to report  potential  fraud  or problems  with  their 
EOMBs.  Table  3 shows  where  beneficiaries  say they  would  report  fraud  or billing  errors. 
Interestingly,  a significantly  higher  percentage  of beneficiaries  with  suspected  errors  on their 
EOMBs  (26 percent)  would  contact  their  health  care provider  as opposed  to those  who  believe 
they  have  encountered  actual  fraud  (9 percent).  This  could  suggest  that beneficiaries  are more 
comfortable  checking  out billing  errors  with  their  physician,  rather  than  accusing  their  physician 
of fraud.  It could  also  suggest  that beneficiaries  do not understand  that  apparent  billing  errors  on 
EOMBs  could  potentially  be a fraud  or abuse  situation. 
Table 3: 
Beneficiaries  would  contact  a variety  of sources 
if they suspected  fraud  or noticed  errors  on EOMB 
Whom  beneficiary  would  i If beneficiary  encountered  / Ifbeneficiarys  EOMB 
con tact  i health  care fraud  (q. 23)  :showed  that Medicare  had 
ipaid for  services  or products 
:not received  (q. 34)
- -- 
Medicare/HCFA  27%  28% 

...............................................................~.................................................................~............................................................... 

Doctor  or hospital  who  i  9%  26% 

committed  the fraud/billed  i 

for services  or products  : 
.............._.._.....................................<.... ............. .
.......................................................$............................................................... 

Insurance  company  that  i  10%  12% 

processes  Medicare  claims  : 

,......................................................i.................
........................................................4............................................................... 
Social  Security  office  11%  6%
,......................................................;................. .
.......................................................f...............................................................
Dont  know  29%  21% 

Of those  beneficiaries  who  had reported  a potential  fraud,  46 percent  reported  it to the doctor  or 
hospital  that  committed  the potential  fraud.  Thirty-three  percent  of beneficiaries  reported  the 
potential  fraud  to Medicare  and 21 percent  reported  it to their  insurance  company. 
7 
 If beneficiaries  knew more, they would be more likely to report potential fraud. 
Almost  nine  out  of  10 beneficiaries  (89 percent)  agree  that if they  knew  more  about  Medicare 
fraud,  they  would  be more  likely  to report  it. 
REACHING  MEDICARE  BENEFICIARIES  THROUGH  OUTREACH 
To look  at the bigger  picture,  beneficiaries  want  to play  a role in stopping  Medicare  fraud  and 
have  taken  the  first  step by reading  their  EOMBs,  but they  are not  sure how  to recognize  fraud 
and where  to report  it.  Therefore,  designing  an education  campaign  to reach  them  is a natural 
step.  When  designing  outreach  campaign  activities  to educate  beneficiaries  and other  citizens 
about  recognizing  and reporting  Medicare  fraud,  it is important  to understand  from  where  they 
receive  information.  This  understanding  can assist  in preparing  the campaign  to reach  as many 
people  as effectively  as possible. 
Magazine  readership  is high among beneficiaries. 
Seventy-two  percent  of beneficiaries  say they  read  magazines  regularly.  We asked  respondents 
to identify  which  magazines  they  read,  and then  we categorized  the magazines  into  12 types  of 
magazines  (e.g.,  news,  womens).  Entertainment  and general  interest  magazines  are the most 
popular  among  respondents  with  40 percent  saying  they  read  a magazine  in that category.  News 
magazines  and womens  magazines  are also popular  with  approximately  one-quarter  of 
beneficiaries.  The  chart  on the following  page  shows  the most  commonly  read  categories  of 
magazines. 
Category  of  Percent  reading 
magazine  regularly 
Entertainment/  40% 
general  interest 
News  25% 
Womens  23% 
Hobbies/crafts/sports  17% 
Homes  & gardens  16% 
We specifically  asked  how  often  beneficiaries  read Modern  Maturity,  AAFCPs magazine.  More 
than  half  say they  read  it; 36 percent  say regularly  and  19 percent  sometimes.  Additionally, 
30 percent  of beneficiaries  read  Ms  The Bulletin  regularly  and  15 percent  sometimes. 
8 
 A large majority  of beneficiaries  regularly receive news through mainstream media. 
Beneficiaries  regularly  read the newspaper  and watch  national  and local  news.  Three  out  of four 
beneficiaries  say they  regularly  read the newspaper.  Eighty  percent  of beneficiaries  say they 
regularly  watch  national  news  on television  and 77 percent  regularly  watch  local  news.  This 
confirms  the  desirability  of using  the mainstream  media,  where  possible,  for the outreach 
campaign. 
Many beneficiaries  watch cable television channels for news and entertainment. 
Almost  two-thirds  (62 percent)  of beneficiaries  say they  regularly  watch  at least  one  cable 
channel.  Because  beneficiaries  commonly  watch  cable  television,  we should  consider  cable  as a 
possible  avenue  for the outreach  campaign. 
9 
 We conducted  this  survey  to prepare  for our outreach  campaign  to educate  beneficiaries  on 
Medicare  fraud  and where  to report  it.  We collected  baseline  data on Medicare  beneficiaries 
current  awareness  of Medicare  fraud  and data on the media  preferences  of beneficiaries. 
The  survey  confirms  the need  for a campaign  to educate  beneficiaries.  Beneficiaries  appear  to be 
on the right  track  with  a large  majority  saying  they  already  always  read  their  EOMBs.  Because 
of the information  provided  on the EOMB,  reviewing  EOMB  statements  is the best  way  to detect 
billing  errors  and potential  fraud.  However,  the survey  results  suggest  that beneficiaries  may  not 
know  what  to look  for on their  EOMBs.  As mentioned  earlier,  AARP  and AoA  have  ongoing 
activities  to address  this.  AARP  is developing  materials  to educate  beneficiaries  about  how  to 
spot  irregularities  on their  EOMBs.  AoA  has funded  projects  to educate  beneficiaries  how  to 
read  their  EOMBs.  The  survey  also found  that  few beneficiaries  know  of the  existence  of a toll-
free Medicare  fraud  hotline  number.  To address  this,  we are working  with  HCFA  to begin 
printing  the phone  number  for the OIG  fraud  hotline  on EOMBs  along  with  a message 
encouraging  beneficiaries  to report  suspected  fraud  and abuse. 
As we prepare  for the launch  of the outreach  campaign  activities,  the outreach  partners  (OIG, 
AoA,  HCFA,  and AARP)  should  keep  in mind  where  beneficiaries  receive  information.  We 
found  that more  than  half  of beneficiaries  read AARPs  magazine,  Modern  Maturity,  regularly  or 
sometimes.  This  makes  Modern  Maturity  an ideal  publication  in which  to print  stories  and 
information  about  Medicare  fraud.  Further,  because  the mainstream  media  has a large  following, 
newspapers  and national  and local  news  programs  may  be effective  avenues  for certain 
components  of the campaign.  Cable  television,  while  not quite  as popular  as the mainstream 
media,  may  also  effectively  reach  beneficiaries  and other  citizens.  AAFP  is developing  public 
service  announcements  for broadcast  media. 
We plan  to repeat  this  survey  after the outreach  campaign  has been  underway  for a year  or two. 
This  will  enable  us to measure  the effect  the outreach  activities  have  had  on Medicare 
beneficiaries  awareness  of Medicare  fraud. 
10 
 1. 	 In the  11 percent,  we included  those  beneficiaries  who  also  said they  dont  know  how 
often  they  read  their  EOMBs. 
2. 	 Beneficiaries  defined  to be knowledgeable  about  Medicare  fraud  are those  who 
answered  yes  to survey  questions  19,21,  or 25.  See appendix  A for survey  questions. 
3. 	 To calculate  the percentage  of beneficiaries  who  have  received  or have  asked  or looked 
for information  on Medicare  fraud,  we added  the results  of survey  questions  19 and 2 1. 
When  a beneficiary  said yes  to both  questions,  we counted  that response  only  once. 
See appendix  A for survey  questions. 
4. 	 To calculate  the percentage  of beneficiaries  who  have  received  or have  asked  or looked 
for information  on Medicare  fraud  from  a variety  of sources,  we added  the results  of 
survey  questions  20 and 2 1A.  When  a beneficiary  said he or she received  information 
from  the  same  source  for both  questions,  we counted  that response  only  once.  See 
appendix  A for survey  questions. 
5. 	 To calculate  the percentage  of beneficiaries  encountering  potential  fraud,  we added  the 
results  of survey  questions  14, 15a, 15b, 15c, and  18 when  a beneficiary  had  a yes 
answer  to one  or more  of the questions.  Each beneficiary  with  more  than  one  yes 
response  was  counted  only  once.  See appendix  A for survey  questions. 
11 
 APPENDIX  A 
Telephone  Survey Instrument and Frequencies 
n=329  respondents 
MEDIA  OUTREACH: 
1. 	 Id like  to know  how  often,  if ever,  you  read  certain  types  of publications,  listen  to the radio,  or 
watch  certain  types  of TV  shows.  How  often  do you  ?  Would  you  say regularly, 
sometimes,  hardly  ever,  or never.  (IF NECESSARY,  READ  SCALE  FOR  EACH 
QUESTION) 
Regularly  Some- Hardly  Never  Dont  Refused 
times  Ever  know 
1A.  Read  a newspaper  75%  11%  5%  8%  0%  1% 
1B.  Watch  NATIONAL  news  80  13  3  3  0  1 
1C.  Watch  LOCAL  news  77  14  5  0  ;1 
1D.  Watch  television  talk  shows  13  19  23  43  0  1 
such  as Oprah,  Rosie  ODonnell,  or 
Gerald0 
1E.  Listen  to public  radio  shows  16  17  15  51  0  /l 
that  invite  listeners  to call in to 
discuss  current  events,  public  issues, 
and politics 
2. 	 Which  of the following  cable  channels,  if any,  do you  watch  regularly?  Do you  watch...? 
(INTERVIEWER:  IF NO CABLE,  ENTER  NO FOR  ALL) 
2A. A&E  (Arts  & Entertainment  Network) 
2B. The  Family  Channel 
2C. Lifetime  65  ~4 
i-- ---- 
I 2D. Discovery  Channel 
I 40  1  /
--+ 
/ 56  42  11  1  : 
A-l  3. 	 Are  there  any magazines  that you  read  regularly? 
72- Yes  (CONTINUE  WITH  Q3A) 
27 - No (SKIP  TO 44) 
O- Dont  Know  (SKIP  TO 44) 
1- Refused  (SKIP  TO 44) 
3A.  Which  magazines? 
(DO  NOT  ASK)  INTERVIEWER  SHOULD  CATEGORIZE.  SELECT  ONLY  ONE  CATEGORY 
PER MAGAZINE:  Which  categories  do they  tend  to fall under? 
25- News 
23-Womens 
54- Seniors 
16- Homes  & Gardens 
17- Hobbies/Crafts/Sports 
8- Literary/Arts  & Science 
40- Entertainment/General  Interest 
8- Nature/Environment 
8- Health  & Nutrition 
2- Regional/Metropolitan/Local 
5- Consumer 
3- Business/Financial 
19- Other 
Regularly  Some- Hardly  Never  ~ Dont  I Refused 
times  Ever  ~ Know 
c  -d---. 
4.  How  frequently  do you  read Modern  36  19  6 

Maturity,  a magazine  produced  by AARP 

(American  Association  of Retired 

Persons)?  Would  you  say... 

+ 
5.  How  frequently  do you  read  AARPs  30  --~I  15  8 

monthly  newspaper  called  The Bulletin? 

Would  you  say... 

-
A-2  6.  Are you  employed  at a regular  full-time  job,  employed  at a part-time  job,  unemployed,  retired,  or a 
homemaker? 	 (RECORD  ALL  MENTIONS) 
6- full-time  job 
5- part-time  job 
4- unemployed 
72- retired 
1O- homemaker 
on disability 
2-
2- other;  specify 
0- dont know 
l- refused 
MEDICARE  FRAUD.  INTERVIEWER  READS:  Now  I am going  to ask you  some  questions  about 
Medicare  fraud.  First,  Im going  to read  several  statements  and then  ask you  whether  you  agree  or 
disagree  with  each  statement.  FOR  PROXY  RESPONDENTS  ONLY:  Your  answers  should  be about 
your  attitudes. 
The  first  statement  is  . AFTER  INTERVIEWEE  RESPONDS  WITH  AGREE  OR 
DISAGREE,  ASK:  Would  that by slightly  or strongly? 
T 
Agree  Agree  Disagree 
strongly  slightly  slightly 
8. 	 Its my personal  responsibility  to  85  9  2 
report  suspected  cases  of 
Medicare  fraud. 
9. 	 Its not worth  the time  and effort  12  5  14  64  I5 
for me to report  and pursue 
suspected  health  care  fraud. 
10 	 If I knew  more  about  Medicare  71  17  4  2  4 
fraud,  I would  be more  likely  to 
report  it. 
L 
11 	 Medicare  fraud  is easy  to  13  9  22 
recognize. 
12  Medicare  fraud  is common.  39  ~ 14  7  7 
A-3  13. 	Are you  aware  of any  agencies  that work  to reduce  Medicare  fraud? 
12 Yes  (CONTINUE  WITH  Q 13A) 
85  No (SKIP  TO 414) 
3- Dont Know  (SKIP  TO Q 14) 
l- Refused  (SKIP  TO Q14) 
13a. Do you  remember  who  they  are?  (RECORD  ALL  MENTIONS) 
42- federal  government;  General  response  (ASK:  Which  agency  or department?) 
The  federal  government:  Medicare  Program/HCFA 
16-
5- The  federal  government:  HHS  Office  of the Inspector  General 
5- The  federal  government:  Justice  Department 
3- The  federal  government:  FBI 
5- State  government:  General  response  (ASK:  Which  agency  or department?) 
3- The  American  Hospital  Association 
37-
Newspapers/media 
8-
5- Other;  please  specify 
13- Dont know 
O- Refused 
INTERVIEWER  READS:  Now  Im going  to ask you  a few questions  about  your  experiences  with 
Medicare.  FOR  PROXY  RESPONDENTS:  For these  next  questions,  you  should  answer  about 
Mr/Mrs  s experiences  with the Medicare  program. 
14. 	While  you  have  been  in the Medicare  program,  do you  think  you  have  ever  encountered  fraud? 
13-Yes  (GO  TO Q14A) 
76-No  (SKIP  TO Q15) 
lo- Dont  Know  (SKIP  TO Q15) 
l- Refused  (SKIP  TO Q 15) 
14A.  Can you  briefly  describe  the fraud  for me? 
14B.  Did you  report  the fraud? 
55-Yes  (GO to Q14C) 
43-No  (SKIP  TO Q15) 
2 _  Dont  Know  (SKIP  TO Q15) 
O- Refused  (SKIP  TO Q 15) 
A-4  14c.  Whom  did you  report  it to? (DO  NOT  READ.  RECORD  ALL  MENTIONS) 
46- The  doctor  or hospital  that committed  the fraud. 
4- A doctor  who  did not commit  the fraud 
2 l- The  insurance  company  that processes  your  Medicare  claims 
4- OIG  Fraud  Hotline 
33- Medicare/  HCFA 
17- Other  (Please  specify  ) 
8 _ Dont know 
O- Refused 
15. 	 While  you  have  been  in the Medicare  program,  (READ  FOR  EACH  QUESTION)  do you  think 
you  have  ever  encountered... 
15A.  A doctor  or other  health  care  provider  that billed  Medicare  for  the same  services  or equipment 
more  than  once? 
6- Yes 
83- No 
1l- Dont Know 
l- Refused 
5B. 	 A doctor  or other  health  care provider  that billed  Medicare  for  services  or equipment  you  did not 
receive? 
9- Yes 
83-No 
8- Dont Know 
1- Refused 
15c.  Health  care  providers  sending  you  equipment  that was not ordered  by your  doctor? 
1- Yes 
95- No 
3- Dont Know 
1- Refused 
16.  Has  anyone  offered  you  medical  equipment  and said that Medicare  would  pay  for it, and it would 
not 	 cost  you  anything? 
6- Yes  (CONTINUE  WITH  Q16A) 
92- No (SKIP  TO Q 17) 
2- Dont Know  (SKIP  TO Q17) 
1- Refused  (SKIP  TO Q 17) 
16A.  What  equipment  was offered? 
A-5 
 16B.  How  were  you  offered  the equipment?  (DO  NOT  READ.  RECORD  ALL  MENTIONS) 
1l- By telephone 
1l- By mail 
1 l- In a medical  supply  store 
42- Doctor  or other  health  care provider/doctors  office 
26- Other 
5- Dont Know 
O- Refused 
17. 	 Has  anyone  offered  you  free  medical  services  or tests? 
9- Yes  (CONTINUE  WITH  Q17A-D) 
90- No (SKIP  TO Q18) 
O- Dont Know  (SKIP  TO Q 18) 
1- Refused  (SKIP  TO Q 18) 
17A.  What  service  or test was offered?  (DO NOT  READ.  RECORD  ALL  MENTIONS) 
21- Cholesterol 
2 l- Blood  pressure 
7- Foot  care 
18- Flu shot 
57-Other 
1 l- Dont know 
O- Refused 
17B.  Where  were  you  offered  the service  or test?  (DO  NOT  READ.  RECORD  ALL  MENTIONS) 
7- In a shopping  mall 
7- At a Health  Fair/Expo 
At a Senior  Center 
21-
14- By telephone 
By  doctor  or other  health  care provider/Drs  office 
18-
39- Other;  please  specify 
4  Dont Know 
01  Refused 
17c.  Did you  take  the service? 
57- Yes  (CONTINUE  WITH  Q17D) 
43-No  (SKIP  TO QlS) 
O- Dont Know  (SKIP  TO Q18) 
O- Refused  (SKIP  TO Q18) 
A-6  17D.  Did you  have  to give  your  Medicare  number  to the person  providing  the free  service  or test? 
38-Yes 
38-No 
19- Dont Know 
6- Refused 
18.  (IF ANSWERED  YES  TO  15 A-C,  16, OR 17D) Were  you  suspicious  of any  of the situations 
or 	suspect  that they  involved  Medicare  fraud? 
43- Yes (CONTINUE  WITH  18A) 
45- No (SKIP  TO Q 19) 
9- Dont Know  (SKIP  TO Q19) 
4- Refused  (SKIP  TO Q 19) 
18A.  What  was the situation? 
ACCESS  TO INFORMATION  ON MEDICARE  FRAUD:  INTERVIEWER  READS:  Now  Im going 
to ask a few  question  about  information  on Medicare  fraud.  FOR  PROXY  RESPONDENTS:  You 
should  answer  these  questions  about  your  own experiences. 
19. 	 Have  you  ever  received  information  on how  to recognize  Medicare  fraud? 
1l- Yes  (CONTINUE  WITH  Q 20) 
81-No  (SKIP  TO Q 21) 
8- Dont Know  (SKIP  TO Q2 1) 
l- Refused  (SKIP  TO 42 1) 
20. 	 who  provided  you  with  information  on how to recognize  Medicare  fraud?  (DO NOT  READ. 
RECORD  ALL  MENTIONS) 
22- Medicare/  HCFA/  Medicare  Handbook 

5- Insurance  company  that processes  your  Medicare  claims 

5- Social  Security  office 

3- Doctor  or other  health  care provider/Doctors  office 

3- Local  senior  center  or seniors  group 

8- TV 

5- Radio  programs 

22- AARP 
1l- Newspaper 

19- Other;  please  specify 

A-7  16- Dont Know 
3- Refused 
21. 	 Have  you  ever  asked  about  or looked for  information  concerning  Medicare  fraud? 
5- Yes (CONTINUE  WITH  Q21A  AND  SKIP  422) 
93- No (SKIP  TO 422) 
1- Dont Know  (SKIP  TO 422) 
1- Refused  (SKIP  TO 422) 
21A. 	 Where  did you  ask about  or look  for information  about  Medicare  fraud?  (DO  NOT  READ 
LIST.  RECORD  ALL  MENTIONS.) 
19- Medicare  /HCFA/  Medicare  Handbook 

13- Medical  claims  statements 

6- Insurance  company  that processes  your  Medicare  claims 

6- Consumer  organizations 

6- Doctor  or other  health 
 care provider/Doctors  office 
13-TV 

6- Radio  programs 

19-AARP 

3 8- Newspapers 

19- Magazines 

6- Other;  please  specify 

6- Dont Know 

O- Refused 

22. 	 Where  would  you  be most  likely  to look  for information  about  Medicare  fraud? 
(DO  NOT  READ.  RECORD  ALL MENTIONS.) 
lo- Medicare/  HCFA/  Medicare  Handbook 

1l- Medical  claims  statements 

3- Insurance  company  that processes  your  Medicare  claims 

1  Insurance  company  that issues  your  supplemental  (Medigap)  policy 

1- Consumer  organizations 

2- Government  agencies-general 

8 _  Social  Security  office 

7- Doctor  or other  health  care provider/Doctors  office/Hospital 

A-8  1- Phone  book/Yellow  pages 
2- Local  senior  center  or seniors  group 
5- TV 
2- Radio  programs 
6-AARP 
1- Internet  or World  Wide  Web 
8- Newspapers 
4- Library 
4- Magazines 
3- Other;  please  specify 
37- Dont Know 
3- Refused 
2- I would  not  look  for information 
23. 	 If you  encountered  health  care  fraud  in the Medicare  program,  whom  would  you  contact?  (DO 
NOT  READ.  RECORD  ALL MENTIONS.) 
9- The  doctor  or hospital  that committed  the fraud. 
3- A doctor  who  did not commit  the fraud 
1O- The  insurance  company  that processes  your  Medicare  claims 

3- The  insurance  company  that issues  your  supplemental  (Medigap)  policy 

1- OIG  Fraud  Hotline 
27- Medicare/  HCFA 
1-AARP
1l- Social  Security  Office 
l- Police 
3- Attorney  general  or district  attorney 

3- Congressperson  or other  elected  representative 

5- Other  Government  agency  (other  than those  listed  above) 

1- Phone  number  on EOMB 

2- Other  (Please  specify  ) 

29- Dont know/  I would  not know  who  to call 

2- Refused 

A-9  24. 	 Would  you  be reluctant  to report  suspected  Medicare  fraud? 
1l- Yes (CONTINUE  WITH  Q24A) 
85-No  (SKIP  TO Q25) 
3- Dont Know  (SKIP  TO 425) 
2- Refused  (SKIP  TO Q25) 
24A.  What would  make  you  reluctant  to report  fraud?  (DO NOT  READ.  RECORD  ALL 
MENTIONS.) 
9- I would  lose  my benefits 
1l- My  doctor  might  get in trouble 
6- Im not  sure what  fraud  is 
9- I dont know  whom  to contact 
3- I dont have  the time 
6- Its not worth  the effort 
20- Would  want  to be sure it is fraud 
9- Concerned  about  retaliation  from  doctor 
14- Dont  want  to get involved 
14-Other 
1l- Dont know 
6- Refused 
25.  Are  you  aware  there  is a toll  free  hotline  to report  Medicare  fraud? 
13- Yes  (CONTINUE  WITH  Q26) 
83- No (SKIP  TO 43 1) 
2- Dont Know  (SKIP  TO 43 1) 
l- Refused  (SKIP  TO 43 1) 
26.  How  did you  hear  about  the hotline?  (RECORD  ALL MENTIONS) 
16- Medicare/  HCFA/  Medicare  Handbook 
12- Medical  claims  statements 
9- Insurance  company  that processes  your  Medicare  claims 
2- Social  Security  office 
2- Doctor  or other  health  care provider/Doctors  office 
2- Local  senior  center  or seniors  group 
14-TV 
A- 10  14-AARP 
5- Friend/family  member 
2- Magazine 
12- Newspaper 
9- Other 
12- Dont Know/Dont  Remember 
O- Refused 
27.  Did you  ever  call the hotline? 
12- Yes  (CONTINUE  WITH  428) 
86  No  (SKIP  TO 43 1) 
O- Dont Know  (SKIP  TO 43 1) 
2- Refused  (SKIP  TO 43 1) 
28.  Were  the recorded  message  and instructions  on the hotline  understandable? 
60-Yes 
O- No 
40- Dont Know/  Dont remember 
O- Refused 
29.  Was the operator  courteous? 
100 Yes 
O- No 
O- Dont Know/  Dont remember 
O- Refused 
30.  How  satisfied  were  you  with  the how your  call was handled?  Would  you  say you  were  very 
satisfied,  somewhat  satisfied,  somewhat  unsatisfied,  or very  unsatisfied? 
60- Very  satisfied 
20- Somewhat  satisfied 
O- Somewhat  unsatisfied 
0  Very  unsatisfied 
20- Dont Know/  Dont remember 
0- Refused 
A- 11  MEDICARE  EOMBs: 

INTERVIEWER  READS:  Now  I am going  to ask questions  about  your  experiences  with  Medicare 

claims  and your  Explanation  of Medicare  Benefits  Statements  (EOMB),  that is the statements  that 

Medicare  sends  out after  a claim  is filed.  FOR  PROXY  RESPONDENTS  ONLY:  These  next 

questions  should  be answered  about your  experiences  with Mr/Mrs  s Medicare  claims  and 

statements. 

31.  How  frequently  do you  read  your  Explanation  of Medicare  Benefits  Statement?  Would  you  say 

always, 	 sometimes,  hardly  ever,  or never? 
74- Always 
13- Sometimes 
4- Hardly  ever 
4- Never 
3- Dont Know 
2- Refused 
32.  Does  anyone  else,  such  as a family  member,  friend,  or professional,  also read  these  Explanation 
Of 	Medicare  Benefits  statements? 
44-Yes  (CONTINUE  WITH  Q32A) 
50-No  (SKIP  TO 433) 
4.  Dont Know  (SKIP  TO 433) 
2- Refused  (SKIP  TO 433) 
32A. 	 Who  is that person?  (RECORD  ALL  MENTIONS) 
70- spouse 
18- son/daughter 
1- parent 
l- doctor 
2  friend 
7  other 
O- dont know 
1- refused 
A- 12  33. 	 Do you  read  anyone  elses Explanation  Of Medicare  Benefits? 
36-Yes  (GO TO 33A) 
62- No (GO  TO 34) 
O- Dont Know  (GO  TO 34) 
2- Refused  (GO TO 34) 
33A.  Whose  do you  read?  (RECORD  ALL MENTIONS) 
13-my  own 
69- spouse 
6- parent 
5- friend 
3- sibling 
9- other  relative 
6- other 
O- dont know 
O- refused 
34. 	 If your  Explanation  of Medicare  Benefits  Statement  showed  that Medicare  had paid  for  services 
or products  you  did not receive,  whom  would  you  contact?  (DO NOT  READ.  RECORD  ALL 
MENTIONS.) 
26- The  doctor  or hospital  that billed  for the services  or products 
2- A doctor  who  did NOT  bill  for the services  or products 
12- The  insurance  company  that processes  your  Medicare  claims 
2- The  insurance  company  that issues  your  supplemental  (Medigap)  policy 
8- OIG  Fraud  Hotline 
28- Medicare/  HCFA 
2- I would  consult  a family  member  or a close  friend 

6- Social  Security  Office 

1- Attorney  general  or district  attorney 

2- Other  Government  agency  (other  than those  listed  above) 

2- Phone  number  on EOMB 

2- Other  (Please  specify  ) 

2 l- Dont know/  I would  not know  who to call/contact 

1- Refused 

A- 13  DEMOGRAPHIC  INFORMATION 

INTERVIEWER  READS:  Finally,  Id like to ask a few questions  for statistical  purposes  only.  As I 

said earlier,  your  answers  will be completely  confidential.  FOR  PROXY  RESPONDENTS  ONLY: 

These  next  questions  should  be answered  about  MrlMrs. 

35.  What  is the highest  level  of education  you  completed? 
19- completed  less than  9* grade 
8- up to and through  11  grade 
34-high  school  graduate 
17- Some  College 
3- Associates  Degree 
9- Bachelors  Degree 
O- Some  Graduate  School 
8- Graduate  or Professional  Degree 
l- Dont Know 
2- Refused 
36.  How  would  you  describe  your  racial  or ethnic  background? 
866 White/Caucasian 
5- Black/African  American 
0.3 Asian  or Pacific  Islander  (1 beneficiary) 
3- Hispanic 
0.6 Native  American  or Alaskan  Native  (2 beneficiaries) 
1- Other--please  specify 
1- Dont Know 
3  Refused 
37.  What  year  were  you  born  in? 
-	 dont know 
refused 
A- 14  38.  What  is your  current  marital  status?  (IF NECESSARY,  Are you  now  married,  widowed, 
divorced,  separated,  single,  or living  as married?) 
59- Married 
27- Widowed 
5- Divorced 
O- Separated 
6- Single 
0- Living  as married 
O- Dont Know 
l- Refused 
39.  What  type  of residence  do you  live  in? 
90- Private  Home/Private  Apartment 
4- Congregate  Senior  Housing  (assisted  living,  senior  apartment  building,  retirement 
community) 
4- Nursing  Home  (IF YES,  SKIP  TO 441) 
O- Other 
O- Dont Know 
2- Refused 
40.  Do you  live  alone,  (just with your  spouse/partner),  or do you  (and your  spouse/partner)  live  with 
other  people? 
29- Alone 
53- Just with  Spouse/Partner 
7- With  Spouse/Partner  and Others 
8- Live  with  Others  (includes  living  with  grown  children) 
O- Dont know 
3- Refused 
A- 15  41.  How  would  you  rate  your  health?  Would  you  rate  it as  excellent,  good,  fair,  or poor? 
2 l- Excellent 
36- Good 
3 l- Fair 
1 l- Poor 
0- Dont Know 
2- Refused 
42.  And  finally,  approximately  what  is your  total  annual  family  income  before  taxes  --just  tell me 
when  I get to the right  category.  (READ) 
18- Less  than  $10,000 
255  $10,000  to under  $20,000 
18- $20,000  to under  $30,000 
1l- $30,000  to under  $40,000 
7- $40,000  to under  $60,000 
5- $60,000  to under  $100,000 
2- $100,000  or more 
5- Dont know 
1O- Refused 
(NOTE  TO INTERVIEWER:  If respondent  is a proxy,  continue  with  Q43.  If there  is no proxy, 
END  THE  SURVEY.) 
FOR  PROXY  RESPONDENTS  ONLY.  INTERVIEWER  READS:  Finally,  I want  to ask you just  a 
few  questions  about  yourself. 
43.  What  is your  relationship  to Mr/Mrs  (the Medicare  beneficiary)?  (i.e.,  are you 
his/her 	 ? 
48- Spouse 
19- Child 
25- Other  Family  Member 
4- Friend 
4- Other 
O- Dont know 
0  Refused 
A- 16  44.  About  how  often  do you  see or talk to Mr/Mrs.  (the Medicare  beneficiary)? 
67- Daily 
19- Several  times  a week 
6- Once  a week 
4- Twice  a month 
4- Monthly 
O- Less  than monthly 
O- Dont know 
O- Refused 
45.  What  is the highest  level  of education  you  completed? 
13- through  8th grade 
6- through  1lth  grade 
19- high  school  graduate 
3 l- Some  College 
O- Associates  Degree 
2 l- Bachelors  Degree 
2- Some  Graduate  School 
4- Graduate  or Professional  Degree 
0- Dont Know 
4- Refused 
46.  And  finally,  what year  were  you  born  in? 
- Dont Know 
Refused 
47.  Proxys  gender 
40- Male 
60- Female 
A- 17  Baseline Statistics 
The  following  tables  show  the point  estimates  and 95 percent  confidence  intervals  for selected 
baseline  statistics  that will  be tracked  over  time. 
Baseline Statistic  Point  95% 
Estimate  confidence  interval 
Percent  of Medicare  beneficiaries  who  74%  69%  - 79% 
always  read  their  EOMBs 
Percent  of Medicare  beneficiaries  who 
are knowledgeable  about  fraud  23%  19% - 28% 
(knowledgeable  defined  as answering  yes to 
survey  questions  19, 21, or 25) 
-. 
Percent  of beneficiaries  who  are not 
aware  of any  agencies  that work  to  88%  84% - 91% 
reduce  Medicare  fraud 
Percent  of beneficiaries  who  do not 
I 
know  there  is a toll-free  hotline  to  86%  82% - 89% 
report  Medicare  fraud 
Of Medicare  beneficiaries  who  say  55%  40%  - 69% 
they  have  encountered  potential  fraud, 
Jercent  who  reported  it. 
B-l  APPENDIX  C 
Confidence  Intervals  for  Selected  Statistics 
In addition  to the baseline  statistics  shown  in appendix  B, the following  table  shows  the point  estimates 
and 95 percent  confidence  intervals  for other  selected  statistics  in the order  they  appear  in the report. 
Statistic  Point  95%  confidence 
estimate  interval 
c 
Percent  of Medicare  beneficiaries  who  agree  that Medicare  fraud  is  53%  48%  - 58% 
common 
-c 
Percent  of Medicare  beneficiaries  who  agree  with  the statement  It  94%  91%  - 96% 
is my personal  responsibility  to report  suspected  cases  of Medicare 
fraud. 
L  c 
Percent  of beneficiaries  who  agree  with  the statement,  Its not  17%  13% - 21% 
worth  the time  and effort  for me to report  and pursue  suspected 
health  care  fraud. 
..-
L  L 
Of beneficiaries  who  always  read  their  EOMBs,  percent  who  are  28%  23%  - 34% 
knowledgeable  about  fraud 
-- 
L  L 
Of beneficiaries  who  sometimes  read  their  EOMBs,  percent  who  are  16%  5% - 27% 
knowledgeable  about  fraud 
- -
L 
Of beneficiaries  who  hardly  ever  or never  read  their  EOMBs,  or  3%  O%-8% 
who  did not know  how  often  they  read  their  EOMBs,  percent  who 
are knowledgeable  about  fraud 
Percent  of beneficiaries  who  disagree  with  the statement,  Medicare  58%  i  53%- 64% 
fraud  is easy  to recognize. 
c 
Percent  of beneficiaries  who  dont  know  whether  they  agree  or  19%  14% - 23% 
disagree  with  the statement,  Medicare  fraud  is easy  to recognize. 
L 
Percent  of beneficiaries  who  have  received  or looked  for  15%  ~  11% - 18% 
information  on Medicare  fraud  (answered  yes to questions  19 or 
21) 
Percent  of beneficiaries  who  say that they  have  encountered 
 19%  15% - 23% 
potential  Medicare  fraud  (answered  yes to questions  14, 15a, 15b, 

or  18) 

- c 
Percent  of beneficiaries  who  have  encountered  a doctor  or other  10%  7% - 13% 
health  care  provider  that billed  Medicare  for services  or equipment 
they  did not receive  (based  on answers  to questions  14a and  15b) 
C-l  Statistic  Point  95%  confidence 
estimate  interval 
-- 
Percent  of beneficiaries  who have  encountered  a doctor  or other  OO  4%-9% 
health  care  provider  that billed  Medicare  for the same  services  or 
equipment  more  than  once  (based  on answers  to questions  14a and  1 
15a) 
~  .;;  m 
Of beneficiaries  with both  (1) an education  beyond  high  school  and  j  0 0  24%  - 49% 
(2) fair  or poor  health,  percent  that encountered  potential  fraud   
Of beneficiaries  with both  (1) an education  beyond  high  school  and  18%  10% - 27% 
(2) excellent  or good  health,  percent  that encountered  potential 
fraud 
Of beneficiaries  with both  (1) high  school  education  or less and (2)  13%  5% - 20% 
fair  or poor  health,  percent  that encountered  potential  fraud  -.. 
Of beneficiaries  with both  (1) high  school  education  or less and (2)  15%  8% - 21% 
excellent  or good  health,  percent  that encountered  potential 
fraud 
Percent  of beneficiaries  who  say they  would  not be reluctant  to  --  1  85%.  -81y/u--
report  Medicare  fraud 
4--
Percent  of beneficiaries  who  dont  know  whom  they  would  :  29%  ~  24%  - 34% 
) 
contact  if they  encountered  Medicare  fraud.  -.  I 
Percent  of beneficiaries  who  would  contact  their  health  care  26%  22%  - 31% 
provider  if they  suspected  errors  on their  EOMBs 
Percent  of beneficiaries  who would  contact  their  health  care  9%  6% - 12% 
provider  if they  encountered  fraud  +  -. 
Percent  of Medicare  beneficiaries  who  agree  that if they  knew  more  ~  89%  I  85%  - 92% 
about  Medicare  fraud.  thev  would  be more  likelv  to renort  it. 
c-2  Analysis of Respondents  Versus Non-respondents 
We compared  survey  respondents  with  both  survey  non-respondents  and the population  of Medicare 

fee-for-service  beneficiaries  using  the following  four variables:  (1) age the beneficiary  attained  during 

1996; (2) gender  of the beneficiary;  (3) race of the beneficiary;  and (4) total  amount  Medicare  paid 

during  1996 on behalf  of the beneficiary.  We found  that respondents  differed  from  non-respondents  by 

age and race but not by gender  or total  Medicare  payment.  Similarly,  we found  that the respondents 

were  representative  of the  fee-for-service  Medicare  population  by gender  and payment  category  but 

were  not  entirely  representative  by age and race. 

In the tables  in this  appendix,  the  All fee-for-service  Medicare  beneficiaries  column  displays 

statistics  that we calculated  from  a l-percent  sample  of Medicare  claims  for services  provided  during 

calendar  year  1996.  In calculating  these  statistics,  we excluded  beneficiaries  who  died  during  1996.  In 

these  tables,  the  sums  of individual  percents  may  not  exactly  equal  100 percent  because  of rounding. 

ANALYSIS  BY AGE 
While  the  difference  between  respondents  and non-respondents  in the average  (mean)  age was  not 
statistically  significant,  the difference  by age group  was  significant.  The  under-65  and  85-and-older 
age groups  are under-represented  among  the respondents,  while  the age 65 to 75 group  is over-
represented. 
Respondents  vs. non-respondents  by average age 
All fee-for-service 
Respondents  Non-respondents 
Medicare  beneficiaries 
N=329  N = 296 
N = 298,970 
.El 
Average  age  72.7  70.9  72.4 
(standard  error)  (O-5)  (0.8)  (0.02) 
T-test  for respondents  vs. non-respondents  by average  age (not  statistically  significant  at the  95 percent 
confidence  level): 
t = 1.907 
degrees  of freedom  = 504.5 
prob>ltl  = 0.0571 
D-l  Respondents  vs. non-respondents  by age group 
m  Respondents  Non-respondents  ~~~~~~~ref.~~~es 
7.3%  19.3%  11.6% 
52.9%  40.9%  45.0% 
31.9%  27.0%  32.2% 
7.9%  12.8%  11.2% 
Chi-square  for respondents  vs. non-respondents  by age group  (statistically  significant): 
chi-square  = 26.928 
degrees  of freedom  = 3 
prob>chi-square  = 0.001 
ANALYSIS  BY RACE 
Respondents  differed  significantly  from  non-respondents  by race.  As shown  in the table  below, 
respondents  who  were  white  were  over-represented  among  respondents. 
Respondents  vs. non-respondents  by race 
All fee-for-service 
Respondents  Non-respondents 
Medicare  beneficiaries 
92.1%  82.7%  86.9% 
7.9%  17.3%  13.1% 
Chi-square  for respondents  vs. non-respondents  by race  (statistically  significant): 
chi-square  = 12.666 
degrees  of freedom  = 1 
prob>chi-square  = 0.001 
D-2 
 ANALYSIS  BY GENDER 
Respondents  did not  differ  significantly  from  non-respondents  by gender,  as shown  in the table 
below. 
Respondents  vs. non-respondents  by gender 
II I
All fee-for-service
Respondents  Non -respondents 
I  Medicare  beneficiaries  II 
II II 
Male  41.9%  I  41.2%  I  40.7% 
II II 
Female  58.1%  I  58.8%  59.3% 
Chi-square  for respondents  vs. non-respondents  by gender  (not  statistically  significant): 
chi-square  = 0.034 
degrees  of freedom  = 1 
prob>chi-square  = 0.854 
ANALYSIS  BY 1996 TOTAL  MEDICARE  PAYMENT 
Respondents  did not  differ  significantly  from  non-respondents  by average  Medicare  payment  (1996 
total  payment  per beneficiary),  as shown  in the tables  below.  In addition  to comparing  average 
payments,  we compared  respondents  with  non-respondents  by payment  categories,  and we did not  find 
any  significant  differences.  An  example  of this  comparison  by payment  category  is shown  in the 
second  table  below. 
Respondents  vs. non-respondents  by average Medicare  payment 
p  _  Respondents  Non-respondents  A1>~~~ce 

Average  (mean)  1996  $4,644  $5,788  $4,609 

Medicare  payment 

(standard  error)  ($724)  ($865)  ($20) 

T-test  for respondents  vs. non-respondents  by average  Medicare  payment  (not  statistically  significant): 
t = -1.0142 
degrees  of freedom  = 59 1.8 
prob+l  = 0.3 109 
D-3 
 Respondents  vs. non-respondents  by Medicare  payment category 
(1  Respondents  Non-respondents  ~~~~~~~~>~~~~es  -
Less  than  $10,000 
86.3%  85.1%  87.4% 
$10.000  or more  13.7%  14.9%  12.6% 
Chi-square  for respondents  vs. non-respondents  by Medicare  payment  category  (not  statistically 
significant): 
chi-square  = 0.180 
degrees  of freedom  = 1 
prob>chi-square  = 0.672 
D-4