Don't be a Victim of Medicare Fraud

Help Keep Costs Down by Helping Medicare

Do you carefully review your paperwork when leaving the doctor? How about those explanation of benefits you get in the mail showing what insurance covered? If you do review them, how much of the information actually makes sense? Most people wouldn’t have favorable answers to these questions and that’s why Medicare fraud, along with other medical fraud is so easy to perpetrate.

But let’s focus on Medicare fraud because it’s so prevalent. It’s hard to put a number on the actual dollar amount but a 2014 estimate put the number somewhere between $17 billion and $57 billion paid out to fraudulent claims. Simply dividing that out across all Medicare recipients, that’s nearly $1,000 per person annually. Fraud of this magnitude certainly has a negative impact on the Medicare program in general, it’s future sustainability, and the cost of individual premiums and deductions each person pays.

You are paying more each month because of Medicare fraud.

Types of Medicare Fraud

In its publication, Protecting Yourself and Medicare from Fraud, Medicare points to improper billing as the most prevalent type of Medicare fraud--charging you for services or equipment you didn’t receive while under the care of a physician, somebody stealing your Medicare ID and billing against it without your knowledge or coning you into signing up for something that you don’t understand and billing Medicare on your behalf.

The easiest way to help in the fight against Medicare Fraud is to read your paperwork, compare it against Medicare’s paperwork, and ask questions of your healthcare provider if something doesn’t seem right.

Step By Step Process

Not sure how to do it? Follow these steps each time you go to the doctor.

  1. When you go to the doctor, keep an electronic or paper calendar of all visits. Write down the provider, what you were seen for, and your copay. Also note any tests performed and medical equipment they gave you.
  2. Ask for paperwork concerning the visit. Often, they’ll give you something to take to the front desk for checkout. Ask for a copy of that paperwork.
  3. If you have Original Medicare they will send you a Medicare Summary Notice or (MSN). This is similar to an EOB or explanation of benefits that you would receive from other health insurance providers. If you have a Medicare Advantage Plan, you will get something similar from that insurance provider.
  1. Compare the MSN or EOB to the paperwork you received from your healthcare provider. Also look at your calendar. If you see anything on the MSN or EOB that you didn’t receive, first call your doctor and ask for clarification. If that doesn’t work, you can report it to Medicare as possible fraud.

Note: You don’t have to wait for actual paperwork to arrive in the mail. Go to mymedicare.gov to see all of your MSNs.

How to Report Medicare Fraud

If you talk to your healthcare provider but still suspect fraud, or you’re receiving documentation from providers you’ve never seen, call 1-800-MEDICARE or file a report online. Have all necessary information ready including your Medicare Number, the name and all identifying information for the person or company you suspect committed fraud, and the related documentation.

If it turns out to be fraud, and you meet certain requirements you could pocket up to $1,000 for reporting.

Protect Yourself

Medicare advises you to protect yourself by following these guidelines:

  • Remember that nothing is actually “free.” Somebody is paying for it.
  • Don’t listen to claims from shady people that say they need your Medicare information in their system but won’t actually charge to it.
  • Nobody from Medicare will show up at your home to sell you anything.
  • You aren’t allowed to receive money or kickbacks for using a service or joining their plan.
  • Don’t fall for scare tactics as a way to sell you medical services or equipment you don’t need. If something seems overly dramatic or scary, seek a second opinion.
  • Don’t use doctors that offer to change a diagnosis code so Medicare will pay for a service.
  • If something seems shady or overly complicated, there’s a good chance that something isn’t right. Get a second opinion.

Finally, treat your Medicare and Social Security cards like a credit card. In the hands of the wrong people, you can become the victim of identity fraud. Not only does that harm Medicare, the amount of time and money you will invest to get it cleaned up will likely be significant. The sooner you report the fraud, the better.