April 7, 2021

How to Protect Yourself from Medicare Fraud

Education
Finance

Throughout the pandemic, scamming and issues with fraud have been rising, especially for older adults. 


That’s why now more than ever, it’s important to protect both yourself (and Medicare) against fraud, as well as report anything suspicious.



What to Know About Medicare Fraud Schemes 


Have you ever randomly been called and asked to provide your Medicare number (known as your Medicare Beneficiary Identifier)? And did you give it to the caller?  Know this now: Medicare and the Social Security Administration will not call you asking for such information.


And if you’re asked to pay for a new card or threatened that you’ll lose your Medicare benefits if you don’t give them money and personal information, it’s time to hang up! Free cards are sent to you upon your request, and your benefits remain unchanged. Medicare cards are unique to the beneficiary and have no expiration date.


If you have lost your Medicare card—don’t worry! You can request a new one for free from the Social Security Administration. Another option is to create a Medicare account on Medicare.gov, and print your card from there.


Medicare card example

How Can I Protect Myself Against Medicare Fraud? 


Here are some top ways to protect yourself against medicare fraud


  1. Review your Medicare claims for errors and report anything suspicious to Medicare.
  2. Whenever you receive health care services, record the dates in a safe place, and save the receipts and statements you get from your providers.  
  3. Compare your health care service information you save with your statement from Medicare and your insurance company; you want to ensure that you received each service listed and that all the details are correct.  
  4. Be sure to review for billing of unnecessary services, misrepresenting dates of service, or providers of service. It should also include the prescriptions that you had filled.  


If you think there’s an error, talk to your provider’s office immediately. They’ll either tell you why the payment notice is correct and help you understand the services or supplies you received, or else they should fix the mistake.  


However, if you find items listed in your claims for which you don’t have a record, it’s possible that you or Medicare may have been billed for services or items you didn’t receive.  


If you've contacted the provider and you do suspect that Medicare is being charged for health care you didn't receive, or you don't know the provider on the claim, it is suggested that you report it.


Further, it’s important to use caution with providers who tell you that the more tests they perform, the less you pay out of pocket. If they offer you gifts as incentives to use their services, or tell you they know how to get Medicare to pay for something that’s not covered under your plan, be wary. Also, be careful with providers who claim that Medicare endorses their products or services, because that might easily not be true. 


How Do I File and Report a Medicare Fraud Claim? 


Medicare claim form example.



When you check your claims early, you may help stop fraud sooner.  Your claims can be found on MyMedicare.gov, or by calling 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

 

If you suspect Medicare fraud, it can be reported in any of these ways:

  • Call 1-800-MEDICARE (1-800-633-4227).
  • TTY users can call 1-877-486-2048.
  • Call the Office of the Inspector General at 1-800-HHS-TIPS (1-800-447-8477).
             TTYY: 1-800-377-4950.


When calling to report Medicare fraud or file a claim, have the following information available:

  • Your name and Medicare Number.
  • The provider's name and any identifying information you may have.
  • The service or item you are questioning, and when it was supposedly given or delivered.
  • The payment amount approved and paid by Medicare.
  • The date on your Medicare Summary Notice or claim.




Keep Yourself Safe from Medicare Fraud

When dealing with any finance related, it’s always important to be vigilant. This includes not just Medicare, but also sharing your information over the phone or online for any reason. 


Keep yourself protected, and when in doubt, ask questions. If you feel like a phone call is suspicious (or they’re requesting anything mentioned in this post), hang up and give Medicare a call about your concerns. Using their personal phone number will allow you to get in contact with the real Medicare office, and they can help you stay safe from Medicare fraud! 


About the Author: 

Jody Cohen is an independent licensed and certified Medicare Plans Specialist and Educator who specializes in helping Arizona seniors understand the healthcare options available to them in the Medicare platform.  She offers a complimentary, thorough needs analysis and reviews the most cost-efficient plan to ensure that medical needs are met with a preferred provider network, and prescription costs are kept to a minimum.  Jody also helps her clients capture all the social programs available to them. We’re excited to announce she’ll be teaching our members about Medicare (and more) in the upcoming months! 


Jody Cohen can be reached at 602-326-4264 or jodycohen@outlook.com.  


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