Today, fraud is extremely common in the business world – and unfortunately, the insurance and Medicare niche is no exception. Just like with everything else, there are always bad people looking to prey on other people. In fact, fraud costs Medicare billions of dollars every year in frivolous claims alone.
Fraud surrounding Medicare can take on a number of different forms, such as:
- Companies using false information in order to mislead individuals into joining a Medicare plan
- Suppliers billing Medicare for equipment and supplies that customers never received
- Companies offering Medicare prescription drug plans that have not received Medicare approval
- Health care providers billing Medicare for services that enrollees never obtained
- Individuals using the Medicare cards and ID numbers of enrollees in order to obtain medical services and supplies illegally
Because Medicare fraud is so widespread, it ends up costing everyone in the form of higher overall health care costs. By eliminating fraud, however, it can help to cut down on costs for individuals, health care providers, and the government. It can also help in increasing the quality of medical services for people who need the care.
Reporting Medicare Fraud
Should you suspect that Medicare fraud has taken place, there are ways that you can report such incidents. In doing so, there is certain information that you should first obtain and have readily available, depending on the particular situation. This includes the following:
- The name and identifying information of the health care or service provider
- Details on the item or service that you are questioning
- The date that the item or service was supposedly delivered or provided
- The payment amount that was supposedly approved by Medicare
- The date that is posted on your Medicare Summary Notice
- Your Medicare ID number
- Any additional information that may be helpful
Once you have the information that is needed, you should contact either the Department of Health and Human Services Office of Inspector General, or the Centers for Medicare and Medicaid Services.
If you think there has been any fraud, it’s important that you report it as soon as possible. In some cases, the fraud could be more widespread than you thought. Eliminating Medicare fraud helps keep spending down and can keep the costs to enrollees down.
Protecting Yourself from Fraud
One of the best ways of preventing Medicare fraud is protecting yourself from it. In doing so, the first and best line of defense is keeping your personal and medical information safe. Some of the best ways of doing so can include not providing your Medicare, Medicaid, or Social Security ID numbers to anyone who is not directly affiliated with such offices or with your health care providers.
In addition, it is important to keep in mind that Medicare does not call or personally visit anyone to sell anything. Therefore, should this occur, you should be on guard in terms of providing the individual (or individuals) who contact you with any personal information.
It is also a good idea to save your Medicare Summary Notices and your Medicare Part D Explanation of Benefits. This way, should there be a discrepancy in the future, you can refer back to the information and compare it with the potentially fraudulent charges and / or services that were not ordered by your medical provider. It is always a good idea to report activity that appears fraudulent. This way, you could potentially put a stop to a situation before it gets even worse.
Common Medicare Frauds
There are several different types of Medicare frauds that are more common than others and you should be on the lookout for. The first type is health care providers or physicians billing Medicare for treatments or services that you never received. This is one of the biggest forms of Medicare that you see in the news. If you notice any suspicious items on your billing documents from your doctor or health care providers, you should either contact them directly or contact your local Medicare office.
There are also dozens of different schemes that target enrollees directly. These vary in technique, but the majority revolves around getting identification information like your birthday and Medicare number.
There are always scammers calling Medicare enrollees suggesting that they need new cards for some false reason. As a precaution, you should never give out personal information over the phone. If your personal information is ever needed (which is more than likely never will), you will be sent an official letter from the Medicare offices.
Be warned, you could even receive phone calls from people that say they are government officials from your local Medicare or Social Security offices. If they ask for any personal information, do not give it to them. Ask for their name and supervisor. You can end the call with them, then call your local office to verify any of the information given to you.
Another common scam that you need to be on the lookout for is any shady supplemental insurance salesman. There are millions of Medicare enrollees that want additional health care coverage that isn’t offered by Medicare, these enrollees then look to buy a Medicare supplemental insurance policy. There are scammers that look to take advantage of these consumers by selling them policies from companies that don’t exist just so they can get their banking information. Before you purchase an insurance policy, make sure that you do your research on the company. Typically doing a few Internet searches on the company name should give you a perfect idea if someone is trying to scam your or if the policy is legitimate. You should never give out any financial information before you’re 100% sure.
If you have any questions about Medicare fraud or your Medicare coverage, please contact us today. Medicare fraud is a serious epidemic and you shouldn’t have to worry about being taken advantage of. Our agents are dedicated to ensuring that you have the health care coverage that you deserve.