For Professionals: Medicare fraud and abuse

CMS Tip Sheet Provides Simple Suggestions on Preventing Medicare Fraud

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Published: December 2006

With the Part D and Medicare Advantage annual enrollment in full swing, the Centers for Medicare and Medicaid Services (CMS) recently published a helpful tip sheet on preventing Medicare fraud. Prevention efforts are of growing importance as the increasing number of plans and Medicare benefits offered by private insurance companies creates more opportunities for potential scams.

PDF Download the tip sheet PDF

This tip sheet reminds beneficiaries to guard their Medicare and Social Security numbers just as they do their credit cards, and not to give out personal information to anyone who comes to their home (or calls them) uninvited. To verify that a Medicare provider, representative, or drug or health plan is legitimate, beneficiaries can call 1-800 MEDICARE (1-800-633-4227). For questions or concerns about any suspicious activity regarding the Medicare Prescription Drug Program, people can also call 1-877-SAFERX (1-877-772-3379), and/or their local Senior Medicare Patrol (SMP) program. To reach the SMP program in California, call Julie Schoen or Anne Gray at 714-560-0309.

Understanding Medicare’s rule regarding what plans are and are not allowed to do helps alert people to potential Medicare scams. Below are some of the rules reviewed in the tip sheet.

People who are really working with Medicare:

  • Can NOT charge a fee to enroll a person in a plan.
  • Can NOT come to a person’s home uninvited to sell or endorse any Medicare-related product.
  • Can call to tell people Medicare drug plans, but they can NOT call if a person has listed their telephone number on the Federal Trade Commission’s (FTC) Do Not Call Registry. Call 1-888-382-1222 or visit www.donotcall.gov for more information on the registry.
  • Can NOT enroll a person into a drug plan of the telephone unless the person called the plan, or unless the person is adding prescription drug coverage to a Medicare Advantage Plan or other Medicare Plan they already have.
  • Can NOT ask for payment over the telephone or web. The plan must send a bill. People can arrange to pay their plan premiums through a monthly withdrawal from their Social Security check or a bank account, but they must call their plan or respond to a mailed payment request from the plan to do this.
  • Can NOT send a person unwanted emails.

Note: Medicare Health Plans that are offering demonstrations or pilot programs are allowed to call potential participants to see if they want to join.

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