For Professionals: Medicare Fraud and Abuse

Slew of 2010 Claims Show Up on Beneficiaries’ Medicare Summary Notices

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Published: July 27, 2011

Medicare recently made a mass adjustment to many previously processed claims from the 1st quarter of 2010. When this happens, these re-processed claims show up again on a beneficiary’s Medicare Summary Notice (MSN). The MSN is a statement, like an explanation of benefits, that lists all Medicare Part A and B services provided to the beneficiary in the last 90 days, what Medicare paid (or didn’t pay and why), what costs, if any, the beneficiary may be liable for, and their appeal rights for any denied claims. We encourage beneficiaries to review their MSN to check that all claims made are for services they received, and to report any claims for services not received. While a mass adjustment is not uncommon, it can cause some alarm for beneficiaries reviewing their MSNs for potential fraud.

Ray Jones, our Senior Medicare Patrol (SMP) volunteer in San Francisco, noted the claims from 2010 when reviewing some of his clients’ quarterly MSNs. He contacted Medicare and was told not to be concerned about this mass adjustment.

Beneficiaries who receive an MSN with a number of old claims should read Medicare’s notes. The note may say something like ”This is an adjustment to a previously processed claim or deductible payment.”

If you have any questions, please call our California Senior Medicare Patrol program at 855-613-8070, or 1-800-MEDICARE. It is good to be extra cautious in reviewing your MSNs as this is an easy place to detect suspicious billing and possible fraud.

See our Medicare Fraud section for more information on our SMP program and information on how to prevent, detect and report fraud.

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