During Medicare’s Annual Enrollment Period (October 15 – December 7), you may see more in the news about Medicare fraud. To help retirees, here is some information on how to avoid Medicare scams.
What is Medicare Fraud?
Medicare fraud is “when Medicare is billed for services or supplies you never receive.” The wrongdoer could be a doctor, a health care professional, a con artist or even an organization that has gained access to your personal information (like your Social Security number, Medicare number, etc.). This is different than incorrect billing. Occasionally, doctors or providers incorrectly submit a Medicare claim for services by using the wrong medical code, which can impact the way your claim is processed and how much you might have to pay. This would not be considered Medicare fraud.
The following are examples of fraudulent activity:
- A health care provider bills Medicare for services you never received
- A supplier bills Medicare for equipment you never received
- Someone uses your Medicare card to get medical care, supplies or equipment
- A company offers a Medicare drug plan that has not been approved by Medicare
- A company uses false information to mislead you into joining a Medicare plan
How You Can Avoid Becoming a Fraud Victim
Guard Your Personal Information
While it may seem obvious, you should be highly discerning about whom you share personal information with (your Medicare number, Social Security number, banking information, etc.). Medicare will never call you to ask for sensitive information, so if you receive a call from a person claiming to be with Medicare, do not give them this information. Con artists and scammers are finding new ways to trick individuals into giving them personal information, and sometimes it is difficult to know who to trust. When in doubt, do not share your information.
Read All of Your Mail Carefully
Scammers looking to gain access to your private health information may send you formal-looking documents, very similar to those from your insurance company or the government, that instruct you to provide personal data. If you do not recognize the sender, do not respond. Many of these scammers count on you not reading your mail closely.
Check Your Statements
As we mentioned above, sometimes what could appear to be Medicare fraud is simply a billing error due to a provider or hospital using the wrong medical code. Always be sure to read insurance and Medicare statements closely. Call your insurance company, your doctor’s office or Medicare if you see something that does not make sense. For clients of RetireMEDiQ, our team is available to help if you are unable to resolve an issue with your doctor’s office or insurance company.
What You Should Do If You Suspect Fraud
RetireMEDiQ, along with the Centers for Medicare and Medicaid Services, insurance companies, and many other organizations take fraud very seriously because we believe that no one should be subjected to scams. What’s more, Medicare fraud and scams waste significant amounts of tax payer dollars each year. Medicare is unable to attribute an exact dollar amount to annual fraud losses, but it is estimated that 10 percent of Medicare’s yearly spending goes to fraudulent activity.
While those numbers are staggering, the good news is that you can help stop these crimes from happening! If you suspect a Medicare scam or fraud, report it to one of the following:
- Customer Service on the medical bill you think is incorrect
- Department of Health & Human Services Office of Inspector General
- Your State Health Insurance Assistance Program (SHIP)
The phone number varies depending on your state; find your state’s number here.
The thought of Medicare scams and fraud can be scary, but rest assured that when in doubt, there are several resources to turn to.