There are several things you can do to help prevent Medicare fraud Medicare fraud occurs when someone knowingly deceives Medicare to receive payment when they should not, or to receive higher payment than they should. See also: Marketing Violations. .
- Protect your Medicare Medicare is the federal government health insurance program that provides health care coverage if you are 65 or older, are under 65 and receive Social Security Disability Insurance (SSDI) for 24 months, begin receiving SSDI due to ALS/Lou Gehrig’s Disease, or have End-Stage Renal Disease (ESRD) no matter your age. You can receive health coverage directly through the federal government (see Original Medicare) or through a private company (see Medicare Advantage). number. Treat your Medicare card Everyone who enrolls in Medicare receives a red, white, and blue Medicare card. It lists your name and the dates that your Original Medicare hospital insurance (Part A) and medical insurance (Part B) began. It also shows your Medicare number, which serves as an identification number in the Medicare system. If you get Medicare through the Railroad Retirement Board, your card will say “Railroad Retirement Board” at the bottom. If you are enrolled in a Medicare Advantage Plan, you will also have a card from that plan (see Medicare Advantage Plan Card). and number the same way you would a credit card number. Only give your Medicare number or your Social Security number to your doctors and other providers. Be careful when others ask for your Medicare number or offer free services if you provide your Medicare number.
- Protect your medical information. Be cautious if people other than your doctors or other medical professionals want to see your medical records or recommend services.
- Learn more about Medicare’s coverage rules. Be careful if a Provider See Health Care Provider. tells you there is a way to get Medicare to cover a service that normally is not covered.
- Do not accept services you do not need. If a provider is pressuring you into getting tests or other services you feel are unnecessary, turn down care or ask to get a second opinion from another physician.
- Be skeptical. It does not hurt to be wary if a provider says Medicare will pay for services that do not sound medically necessary Medically necessary refers to procedures, services, or equipment that meet accepted medical standards and are necessary for the diagnosis and treatment of a medical condition. (mud treatments, Swedish massages, and dance classes are examples of services promised in past fraud cases). Use your best judgment and refer to Medicare’s coverage rules as needed.