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. 

OEI’s 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 “don’t 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. Eightyeight 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, AARP’s 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 twothirds (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 AARP’s 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 .............................................................. 

NEXT STEPS ........................................................... 

ENDNOTES ............................................................ 

APPENDICES ........................................................... 

A. Telephone survey instrument ....................................... 

B. Baseline statistics ................................................ 

C. Confidence intervals for selected statistics ............................ 

D. Respondent and non-respondent analysis ............................. 

. . . 4 

. . 10 

. . 11 

. . . . 

A-l 

. B-l 

. C-l 

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 HCFA’s 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 beneficiary’s 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 President’s 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) 

“don’t 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 “It’s 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 one’s 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 “don’t 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 selfreported 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 / Ifbeneficiary’s 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...............................................................

Don’t 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, women’s). 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 women’s magazines are also popular with approximately one-quarter of 

beneficiaries. 

magazines. 

The chart on the following 

Category of 

magazine 

Entertainment/ 

general interest 

News 

Women’s 

Hobbies/crafts/sports 

Homes & gardens 

page shows the most 

Percent reading 

“regularly” 

40% 

25% 

23% 

17% 

16% 

commonly read categories of 

We specifically asked how often beneficiaries read Modern Maturity, AAFCP’s magazine. More 

than half say they read it; 36 percent say “regularly” and 19 percent “sometimes.” Additionally, 

30 percent of beneficiaries read M’s 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 tollfree 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 AARP’s 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 “don’t 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. I’d 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 Don’t 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 O’Donnell, 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- Don’t 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-Women’s 

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 ~ Don’t 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 AARP’s 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 

2- “on disability” 

2- other; specify 

0- don’t know 

l- refused 

MEDICARE FRAUD. INTERVIEWER READS: Now I am going to ask you some questions about 

Medicare fraud. First, I’m 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 

8. It’s my personal responsibility to 

report suspected cases of 

Medicare fraud. 

9. It’s not worth the time and effort 

for me to report and pursue 

suspected health care fraud. 

10 If I knew more about Medicare 

fraud, I would be more likely to 

report it. 

11 Medicare fraud is easy to 

recognize. 

12 Medicare fraud is common. 

Agree Agree 

strongly slightly 

85 9 

12 5 

71 17 

13 9 

39 ~ 14 

Disagree 

slightly 

2 

14 64 I5 

4 2 4 

L 

22 

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- Don’t 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?) 

16- The federal government: Medicare Program/HCFA 

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-

8- Newspapers/media 

5- Other; please specify 

13- Don’t know 

O- Refused 

INTERVIEWER READS: Now I’m 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- Don’t 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 _ Don’t 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 _ Don’t 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- Don’t 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- Don’t Know 

1- Refused 

15c. Health care providers sending you equipment that was not ordered by your doctor? 

1- Yes 

95- No 

3- Don’t 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- Don’t 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/doctor’s office 

26- Other 

5- Don’t 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- Don’t 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- Don’t 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 

21- At a Senior Center 

14- By telephone 

18- By doctor or other health care provider/Dr’s office 

39- Other; please specify 

4 Don’t Know 

01 Refused 

17c. Did you take the service? 

57- Yes (CONTINUE WITH Q17D) 

43-No (SKIP TO QlS) 

O- Don’t 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- Don’t 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- Don’t Know (SKIP TO Q19) 

4- Refused (SKIP TO Q 19) 

18A. What was the situation? 

ACCESS TO INFORMATION ON MEDICARE FRAUD: INTERVIEWER READS: Now I’m 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- Don’t 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/Doctor’s office 

3- Local senior center or seniors’ group 

8- TV 

5- Radio programs 

22- AARP 

1l- Newspaper 

19- Other; please specify 

A-7 
16- Don’t 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- Don’t 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 

13-TV 

6- Radio programs 

19-AARP 

3 8- Newspapers 

19- Magazines 

6- Other; please specify 

6- Don’t Know 

O- Refused 

care provider/Doctor’s office 

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/Doctor’s 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- Don’t 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 

3- The insurance company 

1- OIG Fraud Hotline 

27- Medicare/ HCFA 

1AARP -

1l- Social Security Office 

l- Police 

that processes your Medicare claims 

that issues your supplemental (Medigap) policy 

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- Don’t 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- Don’t Know (SKIP TO 425) 

2- Refused (SKIP TO Q25) 

24A. What would make you reluctant to report fraud? (DO NOT READ. RECORD ALL 

25. 

26. 

MENTIONS.) 

9- I would lose my benefits 

1l- My doctor might get in trouble 

6- I’m not sure what fraud is 

9- I don’t know whom to contact 

3- I don’t have the time 

6- It’s not worth the effort 

20- Would want to be sure it is fraud 

9- Concerned about retaliation from doctor 

14- Don’t want to get involved 

14-Other 

1l- Don’t know 

6- Refused 

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- Don’t Know (SKIP TO 43 1) 

l- Refused (SKIP TO 43 1) 

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/Doctor’s office 

2- Local senior center or seniors’ group 

14-TV 

A- 10 
27. 

28. 

29. 

30. 

14-AARP 

5- Friend/family member 

2- Magazine 

12- Newspaper 

9- Other 

12- Don’t Know/Don’t Remember 

O- Refused 

Did you ever call the hotline? 

12- Yes (CONTINUE WITH 428) 

86 No (SKIP TO 43 1) 

O- Don’t Know (SKIP TO 43 1) 

2- Refused (SKIP TO 43 1) 

Were the recorded message and instructions on the hotline understandable? 

60-Yes 

O- No 

40- Don’t Know/ Don’t remember 

O- Refused 

Was the operator courteous? 

100 Yes 

O- No 

O- Don’t Know/ Don’t remember 

O- Refused 

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- Don’t Know/ Don’t 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- Don’t 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. Don’t 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- don’t know 

1- refused 

A- 12 
33. Do you read anyone else’s Explanation Of Medicare Benefits? 

36-Yes (GO TO 33A) 

62- No (GO TO 34) 

O- Don’t 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- don’t 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 

2- A doctor who did NOT 

12- The insurance company 

2- The insurance company 

8- OIG Fraud Hotline 

28- Medicare/ HCFA 

that billed for the services or products 

bill for the services or products 

that processes your Medicare claims 

that issues your supplemental (Medigap) policy 

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- Don’t know/ I would not know who to call/contact 

1- Refused 

A- 13 
DEMOGRAPHIC INFORMATION 

INTERVIEWER READS: Finally, I’d 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. 

36. 

37. 

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- Don’t Know 

2- Refused 

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- Don’t Know 

3 Refused 

What year were you born in? 

- don’t know 

refused 

A- 14 
38. 

39. 

40. 

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- Don’t Know 

l- Refused 

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- Don’t Know 

2- Refused 

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- Don’t know 

3- Refused 

A- 15 
41. 

42. 

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- Don’t Know 

2- Refused 

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- Don’t 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- Don’t know 

0 Refused 

A- 16 
44. 

45. 

46. 

47. 

About how often do you see or talk to Mr/Mrs. 

67- Daily 

19- Several times a week 

6- Once a week 

4- Twice a month 

4- Monthly 

O- Less than monthly 

O- Don’t know 

O- Refused 

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- Don’t Know 

4- Refused 

And finally, what year were you born in? 

- Don’t Know 

Refused 

Proxy’s gender 

40- Male 

60- Female 

(the Medicare beneficiary)? 

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 

always read their EOMBs 

Percent of Medicare beneficiaries who 

are knowledgeable about fraud 

(“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 

reduce Medicare fraud 

Percent of beneficiaries who do not 

know there is a toll-free hotline to 

report Medicare fraud 

Of Medicare beneficiaries who say 

they have encountered potential fraud, 

Jercent who reported it. 

74% 69% - 79% 

23% 19% - 28% 

88% 84% - 91% 

I 

86% 82% - 89% 

55% 40% - 69% 

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 

Percent of Medicare beneficiaries who agree that Medicare fraud is 

common 

Percent of Medicare beneficiaries who agree with the statement “It 

is my personal responsibility to report suspected cases of Medicare 

fraud.” 

Percent of beneficiaries who agree with the statement, “It’s not 

worth the time and effort for me to report and pursue suspected 

health care fraud.” ..-

Of beneficiaries who always read their EOMBs, percent who are 

knowledgeable about fraud 

Of beneficiaries who sometimes read their EOMBs, percent who are 

knowledgeable about fraud - -

Of beneficiaries who hardly ever or never read their EOMBs, or 

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 

fraud is easy to recognize.” 

Percent of beneficiaries who “don’t know” whether they agree or 

disagree with the statement, “Medicare fraud is easy to recognize.” 

Percent of beneficiaries who have received or looked for 

information on Medicare fraud (answered “yes” to questions 19 or 

21) 

Percent of beneficiaries who say that they have encountered 

potential Medicare fraud (answered “yes” to questions 14, 15a, 15b, 

or 18) -

Percent of beneficiaries who have encountered a doctor or other 

health care provider that billed Medicare for services or equipment 

they did not receive (based on answers to questions 14a and 15b) 

C-l 

Point 95% confidence 

estimate interval c 

53% 48% - 58% 

-c 

94% 91% - 96% 

L c 

17% 13% - 21% 

L L 

28% 23% - 34% 

L L 

16% 5% - 27% 

L 

3% O%-8% 

58% i 53%- 64% 

c 

19% 14% - 23% 

L 

15% ~ 11% - 18% 

19% 15% - 23% 

c 

10% 7% - 13% 
-- 

-- 

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 

(2) “fair” or “poor” health, percent that encountered potential fraud ’ 

Of beneficiaries with both (1) an education beyond high school and 

(2) “excellent” or “good” health, percent that encountered potential 

fraud 

Of beneficiaries with both (1) high school education or less and (2) 

“fair” or “poor” health, percent that encountered potential fraud 

Of beneficiaries with both (1) high school education or less and (2) 

“excellent” or “good” health, percent that encountered potential 

fraud 

0 0 24% - 49% 

18% 10% - 27% 

13% 5% - 20% 

-.. 

15% 8% - 21% 

Percent of beneficiaries who say they would not be reluctant to 1 85%. -81y/u--­

report Medicare fraud 

4--

Percent of beneficiaries who “don’t 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 overrepresented. 

Respondents vs. non-respondents by average age 

All fee-for-service 

Respondents Non-respondents Medicare beneficiaries 

N=329 N = 296 

.El N = 298,970 

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 

All fee-for-service IIRespondents Non -respondents 

I IMedicare beneficiaries II 

IIMale II 41.9% I 41.2% I 40.7% 

IIFemale II 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