How to Stop Medicare Fraud
- Examine both the Medicare Summary Notice (MSN) you receive from Medicare after your claims are paid and the Explanation of Benefits you receive from your Part D plan after purchasing prescription drugs. Ask yourself:
- Did I receive all the services/prescriptions listed?
- Did my doctor order these services?
- Do the prescriptions listed match my prescriptions?
- Are the dates of the services/prescriptions correct?
- Are the dollar amounts shown the same as those on my bill?
- Protect your Medicare card number as well as your Social Security number. Don't give these numbers to anyone over the phone or in person, unless you initiated the conversation, you know the person, and you write down their name, number and title.
- Don't leave your Medicare number in a phone message.
- Don't accept any offer of "free" services or supplies in return for your Medicare number.
- Don't let anyone convince you to see a doctor for a service you don't need.
- Don't accept offers of money, free food or gifts for medical care.
- Never accept medical supplies from door-to-door salespeople.
- Don't be influenced by media advertisements concerning your health. Their main purpose is to raise money, and they don't have your best interests at heart.
- Avoid scams that include the following incentives:
- "It's free!"
- "We know how to bill Medicare."
- Educate yourself about Medicare. Know your rights as well as what type of medical care providers can and cannot offer.
- Ask questions. You have a right to know about your medical care.
How to Report Suspected Medicare Fraud
Follow the steps below if you think Medicare should not have paid for an item listed on your Medicare Summary Notice (MSN), you shouldn't have been charged for drugs listed on your Part D Explanation of Benefits (EOB) or you suspect Medicare fraud. Be sure to have your MSN and/or Part D EOB with you when you call so you can provide as much information as possible about the item in question.
- Call the health care provider listed on the MSN or Part D EOB and inquire about the questionable item. In many cases, it may be the result of a billing error, which can easily be corrected.
- If your question is not resolved and you still think the charges are fraudulent, contact a Senior Medicare Patrol (SMP) counselor at your local Health Insurance Counseling and Advocacy Program (HICAP) office online or at 1-800-434-0222. The counselor will ask you for the pertinent facts and begin to review your concern. If appropriate, the counselor can help forward your case to the proper fraud investigation agency.
- You can also contact the U.S. Department of Health and Human Services, Office of Inspector General online or at 1-800-HHS-TIPS (1-800-447-8477). Your SMP counselor will help you determine if this step is necessary.
Learn More
If your group or organization would like a free presentation about Medicare fraud and how to prevent it, contact a Senior Medicare Patrol (SMP) counselor at your local HICAP office online or at 1-800-434-0222. California's SMP project is funded through the Administration on Aging.