How can I protect myself from Medicare fraud?

Dear Barb, 

It’s understandable to be concerned! Luckily, there are steps you can take to be vigilant. Medicare fraud can take different forms and happen at various times. For example, Medicare fraud can happen:  

• Before you enroll in a Medicare Advantage or Part D plan 
• When you go to a doctor’s office or a facility 
• When people see your electronic or physical medical records without your permission  

June 2-6 is Medicare Fraud Prevention Week. The best way to stop fraud from happening is to stop it in the first place. Learning how to prevent Medicare fraud, errors, and abuse and then sharing what you learn is the best place to start. 

Below are some common Medicare fraud patterns. Knowing them can help you recognize higher risk situations and take actions to protect yourself from Medicare fraud. 

Billing fraud 

Billing fraud occurs when Medicare, and you, are charged for services you didn’t need or receive. It could be from a provider you didn’t see at all. Or your provider could include inaccurate claims along with legitimate ones. Keep in mind that:  

• Suppliers should not send you equipment, supplies, or orthotics that you did not ask for.  
• Your doctor should not charge you cost-sharing for most preventive services. 
• Your doctor should not offer tests or other services that you don’t need. This is true especially if they offer incentives for accessing those services. 
• If you return durable medical equipment (DME), your supplier should not continue to charge Medicare for rental fees or maintenance. 

Always check that you received the services listed on either your Medicare Summary Notice (MSN) or your Explanation of Benefits (EOB).  

Misleading marketing  

Misleading marketing can involve misrepresenting the benefits you are entitled to through Medicare or Medicaid. It can also involve pressuring or threatening you with negative outcomes if you do not enroll. Someone may try to improperly influence your decision to enroll in a Medicare Advantage or Part D plan.  

Always verify any marketing information you receive in the plan’s benefit manual. You can do so online or by calling the plan directly.  

Never feel pressured to join any plan. Always make sure you understand what the plan is offering you, and how all your benefits are affected. Ask for written information about the plan’s benefits. If you suspect that an agent isn’t following the rules, keep documented proof. For example, the agent’s business card or marketing materials.  

If you enrolled in a plan due to misleading marketing, you may be eligible for a Special Enrollment Period (SEP) to disenroll from your plan and switch to another one. 

To report fraud contact: 

• 1-800-MEDICARE (633-4227) 
• Senior Medicare Patrol (SMP) Resource Center (877-808-2468) 
• Inspector General’s fraud hotline at 1-800-HHS-TIPS (447-8477) 

Remember the three steps from the SMP: Prevent, Detect, Report! 

• Prevent: Open and read your Medicare statements. 
• Detect: Look for things like double charges or services you don’t recognize. 
• Report: Contact the SMP for questions or concerns. 

Find your local SMP at www.smpresource.org. 

Hope this helps and puts your mind at ease! 

-Marci