Medicare Fraud: What’s Going On Now

Medicare fraud

Health care is a common target for thieves. The total health care spending in America was a whopping $3.3 trillion in 2016. Punishments for healthcare fraud have grown tougher recently. 

As fraud-fighting has picked up, sketchy billing has shown up in places that were most prone to the abuse, such as durable medical kits and home visits. Since more intensive screening was introduced under Obamacare, the Centers for Medicare and Medicaid Services have taken away over 17,000 providers’ licenses to bill Medicare. But the sheer volume of transactions is making it easier for thieves to hide out.

Current Scams

Many of the current scams are phone calls of people claiming they found out you were eligible for a certain service. Even though it seems these people know something about you, they are not from Medicare. 

(1) Calls saying you are eligible for durable medical equipment and asking for your Medicare number.

(2) Calls or emails from people impersonating the IRS.

(3) Phone calls offering neck, shoulder, or knee braces.

(4) Phone calls claiming to be from Medicare saying they need to update your information.

(5) Phone calls from “medical service groups” offering pain medications or pain creams. 

(6) With new Medicare cards being issued this year, cases of fraud are popping up. People are calling seniors asking them to give out their information in order to receive a new Medicare card. Don’t share your personal information or Medicare number over the phone; Medicare will not call you to ask for your information. As long as Social Security has your current address on file, you will receive a new card between April 2018 and April 2019. When your receive your new Medicare card, destroy you old card. Keep your Medicare Advantage card with you.  

To see the latest large health care fraud schemes across the country, visit the Medicare Fraud Task Force

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How to Spot Fraud

Protect yourself and Medicare against fraud by watching your Medicare claims for errors and reporting anything suspicious to Medicare.

  • Compare the dates and services on your calendar with the statements you get from Medicare to make sure you got each service listed and that all the details are correct.
  • If you find items listed in your claims that you don’t have a record of, it’s possible that you or Medicare may have been billed for services or items you didn’t get.
  • If you think a charge is incorrect and you know the provider, you may want to call their office to ask about it. The person you speak to may help you better understand the services or supplies you got. Or, your provider may realize a billing error was made.
  • If you’ve contacted the provider and you suspect that Medicare is being charged for health care you didn’t get, or you don’t know the provider on the claim, find out how to report fraud.

How to Prevent Fraud 

According to the Medicare.gov website, these are the do’s and don’ts of Medicare fraud:

Do’s

  • Do protect your Medicare Number and your Social Security Number.
  • Do remember that nothing is ever “free.” Don’t accept offers of money or gifts for free medical care.
  • Do ask questions. You have a right to know everything about your medical care including the costs billed to Medicare.
  • Do educate yourself about Medicare. Know your rights and know what a provider can and can’t bill to Medicare.
  • Do use a calendar to record all of your doctor’s appointments and what tests or X-rays you get. Then check your Medicare statements carefully to make sure you got each service listed and that all the details are correct. If you spend time in a hospital, make sure the admission date, discharge date, and diagnosis on your bill are correct.
  • Do be wary of providers who tell you that the item or service isn’t usually covered, but they “know how to bill Medicare” so that Medicare will pay.
  • Do make sure you understand how a plan works before you join.
  • Do always check your pills before you leave the pharmacy to be sure you got the correct medication, including whether it’s a brand or generic and the full amount. If you don’t get your full prescription, report the problem to the pharmacist.
  • Do report suspected instances of fraud.

Don’ts

  • Don’t allow anyone, except your doctor or other Medicare providers, to review your medical records or recommend services.
  • Don’t contact your doctor to request a service that you don’t need.
  • Don’t let anyone persuade you to see a doctor for care or services you don’t need.
  • Don’t accept medical supplies from a door-to-door salesman. If someone comes to your door claiming to be from Medicare or Medicaid, remember that Medicare and Medicaid don’t send representatives to your home to sell products or services.
  • Don’t be influenced by certain media advertising about your health. Many television and radio ads don’t have your best interests at heart.
  • Don’t give your Medicare card, Medicare Number, Social Security card, or Social Security number to anyone except your doctor or people you know should have it.

How to Report Fraud

You can report suspected Medicare fraud in any of these ways, according to the Medicare.gov website:

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Hannah Verret is a content developer at Medicare World in Memphis, TN. Hannah has been working in content creation throughout her entire adult career. When Hannah isn’t writing or organizing social media posts, she’s spending her time reading and loving on her many pets.