Medicare offers vital services to ensure individuals receive the medical care they need. However, alongside the benefits of Medicare, there is also the unfortunate reality of Medicare fraud.

Fraudulent activities can result in significant financial losses for Medicare and its beneficiaries. It is essential to be aware of the different types of Medicare fraud, understand how a Medicare broker gets paid, how to protect yourself against scams and know the proper steps to report suspected fraudulent activities. By equipping yourself with this knowledge, you can protect your healthcare coverage and contribute to the fight against Medicare fraud.

Recognizing Medicare Fraud

Medicare fraud can take various forms. Let’s look at some common examples:

Billing for services or supplies you never got: Providers could bill Medicare for services or medical equipment never provided to you.
Phantom billing: Scammers could create fictitious healthcare clinics or practices and bill Medicare for services that were never rendered.
Prescription drug fraud: This example involves unlawfully obtaining prescription drugs or overcharging for medications covered by Medicare.
Identity theft: By stealing Medicare beneficiaries’ personal information, they can use it to submit fraudulent claims.
Upcoding or unbundling: Healthcare providers may bill Medicare for a higher-priced service than the one performed or separate services that should be billed together as a package.

Protecting Yourself from Medicare Fraud

To safeguard yourself against Medicare fraud, consider these steps:

Protect your Medicare number: Treat your Medicare card like a credit card and never share your Medicare number with anyone except trusted healthcare providers and representatives.
Be wary of unsolicited offers: Be suspicious of individuals who contact you by phone, email, or door-to-door visits offering free medical services or equipment. Legitimate healthcare providers do not typically engage in those types of unsolicited communication.
Review your Medicare Summary Notice (MSN): Regularly review your MSN to ensure the services listed were received. Look for any unfamiliar providers, services, or supplies.
Keep accurate records: Maintain a file of your medical appointments, prescriptions, and communication with healthcare providers. This can serve as evidence in cases of suspected fraud.
Be cautious of free services or equipment: Be careful when accepting free medical services. Verify the authenticity of the provider and confirm they are Medicare-approved.

Reporting Medicare Fraud

If you suspect Medicare fraud, report it promptly. By reporting suspected fraud, you help protect yourself and the Medicare program. Here are the steps to follow when reporting Medicare fraud:

Contact the Medicare Fraud Hotline: You can report suspected fraud by calling the Medicare Fraud Hotline at 1-800-HHS-TIPS (1-800-447-8477).
Provide necessary information: When reporting suspected fraud, give as much detail as possible, such as the names of the individuals or organizations involved, the services or items in question, and any supporting documentation you collected.
Shield your identity: If you wish to remain anonymous, you can do so. However, providing your contact information can be helpful if investigators need additional information.
Notify law enforcement agencies: If you believe you have been a victim of Medicare fraud, consider filing a report with your local law enforcement agency, such as your state attorney general’s office or the Federal Bureau of Investigation (FBI).

Stay Informed

Staying informed about Medicare fraud trends and scams is crucial to protect yourself. Unfortunately, scammers are constantly finding new ways to trick you into giving them your personal information. Here are some tips to help you remain vigilant:

Educate yourself: Stay updated on the latest Medicare fraud schemes and tactics. Medicare’s official website and the Office of Inspector General’s website provide valuable resources to help you stay informed.
Be skeptical of too-good-to-be-true offers: Exercise caution when approached with offers that promise free services, equipment, or benefits that seem too good to be true. You know the saying: If it sounds too good to be true, it probably is.
Consult trusted sources: Seek guidance from trusted healthcare providers or Medicare brokers. Brokers can help educate you about Medicare and assist with your plan enrollments. There are no charges for their services. SHIP representatives can also verify the legitimacy of any healthcare services or equipment.
Look over your Medicare Summary Notice (MSN) promptly: Carefully review your MSN as soon as it arrives. Report any discrepancies or suspected fraud immediately.
Protect your personal information: Take care of your personal information, including your Medicare number, social security number, and date of birth. Only give this information to trusted healthcare professionals and authorized Medicare representatives.

Be on alert

By following these preventive measures and reporting any suspected fraudulent activities, you can play an active role in combating Medicare fraud and protecting your healthcare coverage. Remember, knowledge is power in safeguarding yourself and the Medicare program from fraudulent activities. Stay informed, be vigilant, and help ensure that Medicare continues to serve its intended purpose of providing quality healthcare to those in need.