This site works best with the latest version of Edge, Firefox, Chrome or Safari.

How to Avoid Medicare Fraud

Your Medicare Number is the key to your health coverage. But if it ends up in the wrong hands, you could be dealing with fraudulent charges or medical identity theft, which has impacted more than two million American victims. Even if you avoid a scam, ongoing fraud is costly for Medicare. That increasing cost means higher deductibles, bigger copayments, and cuts to services and care.

Luckily, there are simple steps you can take to recognize and report Medicare fraud. By catching fraudulent activity early, you can protect yourself and help all Medicare beneficiaries.  Take these measures to keep your Medicare coverage from fraud:

 

Know what to expect from Medicare

To recognize suspicious Medicare activity, it’s important to understand how and why Medicare communicates with its members. According to the Centers for Medicare & Medicaid Services (CMS), sponsors and agents for Medicare, Medicare Advantage, and Medicare supplemental plans may only contact current enrollees to discuss plan types or benefits. Be wary of unusual communication or any requests for your Medicare Number.

 Medicare will never:

·       Call to ask for your Medicare Number or personal information unless you left a message on Medicare’s customer service line getting your permission in advance

·       Call to sell you anything

·       Visit you at home without a scheduled appointment

·       Enroll you over the phone unless you initiated the call

Protect your Medicare Number

Your Medicare Number is similar to your social security or credit card numbers. You are at risk for identity theft if it gets into the wrong hands. But unlike credit cards, your Medicare card offers no consumer protection. To safeguard yourself, be cautious of sharing your Medicare card or number with anyone. Exceptions include your doctor, close family members or other Medicare providers that you trust. If you are unsure whether to give someone access to your number, call Medicare first to check.

Remember that your Medicare Number also appears on your medical records and statements. Do not share these documents with anyone. When disposing of old statements, shred the paperwork so the number is illegible.

Log your use of Medicare coverage

Keep a thorough record of all medical visits, receipts, and prescriptions. Mark your doctors’ appointments on a calendar to easily cross-check service dates with your insurance statements. After a physician visit, examine the receipt immediately for mistakes. If you don’t understand a charge, ask your provider’s office to explain.

Check your Medicare claims and statements

Whether you have Original Medicare, a Medicare Advantage Plan, or a Medicare Supplemental Plan, you’ll receive regular statements outlining the services used. If you have Original Medicare, a Medicare Summary Notice (MSN) comes every three months by mail or every month by email (if you choose to receive MSNs electronically). For Medicare Advantage Plans, the statement frequency varies by plan.

Compare your MSN or statement and any processed claims to your calendar and receipts. Take time to verify the dates of service, the providers seen, and the amount charged. If the statement comes at an odd time or any of the details are incorrect or suspicious, contact Medicare or your insurance company immediately.

Whether you have Original Medicare, a Medicare Advantage Plan, or a Medicare Supplemental Plan, you’ll receive regular statements outlining the services used. If you have Original Medicare, a Medicare Summary Notice (MSN) comes every three months by mail or every month by email (if you choose to receive MSNs electronically). For Medicare Advantage Plans, the statement frequency varies by plan.

Compare your MSN or statement and any processed claims to your calendar and receipts. Take time to verify the dates of service, the providers seen, and the amount charged. If the statement comes at an odd time or any of the details are incorrect or suspicious, contact Medicare or your insurance company immediately.

Report Medicare fraud

If you suspect fraudulent activity in connection with your Medicare coverage, report it right away. If you have Original Medicare, you can call 1-800-MEDICARE (800-633-4227). For fraud associated with a Medicare Advantage Plan or Medicare Supplemental Plan, call the Medicare Drug Integrity Contractor at 877-772-3379. Before making the call, be sure to have:

·       Your Medicare Number

·       The provider’s name and information

·       The date of the service in question

·       The amount approved and paid by Medicare

·       The date on your MSN or claim