How to Protect Yourself from Medicare-Related Fraud

The American government loses billions of dollars in taxpayer money to Medicare fraud and medical identity theft annually. Because these types of fraudulent activities can affect any Medicare recipient at any time, it’s important for you to be aware of how scammers commit fraud most commonly and how you can help avoid it from happening to you. 

Medicare Benefits Solutions

Dec 29, 2020

 4 minutes read

What are the most common types of Medicare fraud?

Fortunately, most healthcare providers are extremely careful and trustworthy when making billing claims to Medicare for services, procedures, and supplies that they have provided to their Medicare patients. Unfortunately there are people that purposely use fraudulent tactics. Some providers make innocent errors on claims and Medicare beneficiaries need to keep an eye out for them. But it’s even more important for everyone who has Medicare to be aware of common ways that some providers take advantage of the system.  

A health care provider can commit Medicare fraud by upcoding and unbundling. This happens if they bill Medicare for services or supplies you haven’t gotten, or they bill for services or supplies that are more expensive than those you have received. A provider might also keep billing Medicare for durable medical equipment rental after you have returned it to the supplier.
Not only is upcoding costly to American taxpayers, it might also harm you in the future. If you end up needing the procedure, service, or supplies your health care provider claimed falsely that you had, you probably won’t get coverage for it again. Another way some health care professionals commit Medicare fraud is by offering to perform a service or procedure that you don’t actually need. This way the provider can make a claim to Medicare for the extra service.

Healthcare providers sometimes get kickbacks for patient referrals which puts your personal medical information at risk if scammers use it to open fraudulent claims. It is also possible that a health care professional could use your Medicare number for another patient’s procedures or services. 

How can you protect yourself from Medicare fraud?

Whenever you use your Medicare benefits for healthcare services or supplies, make a detailed note of it on a smartphone, tablet, calendar or in a dedicated notebook. Save all your receipts and statements in the same place when you get them from your providers, too.

If you have Original Medicare, you get a Medicare Summary Notice every three months. If you have a Medicare Advantage plan, you get periodic statements from your provider. When you get yours, sit down and compare the listed charges with your notes, receipts, and statements. Your quarterly statement should only have charges for services and supplies you have had and noted separately.

If there are differences and you suspect fraud, first call the health care provider to make sure a mistake wasn’t made. If that doesn’t resolve the problem, call Medicare’s toll free number: 1-800-633-4227, or the Department of Health and Human Services fraud hotline: 1-800-447-8477.

How can you protect yourself against identity theft?

To ensure that no one else uses your Medicare identification number to make false claims, protect yourself by taking the following precautions:

• Don’t give your personal information or your Medicare identification number to anyone who calls you, emails you, or asks you for this information in person. 

• Remember, Medicare representatives won’t call to get personal information unless it’s for a Medicare health care or drug plan that you are already a member of. Or, if a customer service representative is returning your call to 1-800-MEDICARE where you’ve left a message.

• If someone calls you asking for your information and says they are from Medicare, you should hang up and call Medicare’s official toll-free number. 

It is true that most healthcare professionals are honest and want to do their part in protecting Medicare and the American taxpayers from Medicare fraud. But if you ever feel that you are a victim of fraud or identity theft, be sure to call Medicare immediately to set things straight. 

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