We’ve all heard about Medicare fraud. It can be committed by physicians, other healthcare providers, and program enrollees. But would you know it if you saw it? Millions in taxpayer dollars are lost to Medicare fraud each year.
According to the U.S.Government Accountability Office (GAO), $52 billion in improper Medicare payments were made in fiscal year 2017. Simply put, fraud occurs when a person charges Medicare for a cost they didn’t incur, or they receive more money for a charge than they should. Meanwhile, Medicare abuse is defined as practices that create unnecessary costs to the program.
Original Medicare & Fraud
Do you have Medicare Part A (hospitalization coverage) and Part B (outpatient medical coverage)? If so, your physician should not charge you for the majority of preventative services you seek. Nor should they suggest tests you don’t need. Another red flag is if your provider regularly waives your coinsurance. Each time you receive either an Explanation of Benefits (EOB) or a Medicare Summary Notice (MSN), be sure to confirm you actually received the services that are listed.And if you returned durable medical equipment, confirm the supplier doesn’t keep charging Medicare for either rental fees or equipment maintenance.
Medicare Marketing Fraud
Let’s say you’re speaking with an insurer about signing up for Medicare. Beware if an agent or other company representative states any of the following:
• You have to sign up for a Medicare Advantage plan to get Medicare Part D prescription drug coverage
• You have to invite an agent into your home to receive plan details or sign up
• You will receive “additional” benefits that are, in fact, covered by Medicare
All of the above statements are untrue. For the actual facts, refer to the Medicare plan benefits guide, or call the insurer directly.
Reporting Medicare Fraud
In summary, Medicare fraud costs taxpayers billions of dollars each year. Do your part by contacting the Centers for Medicare and Medicaid Services if you suspect fraud. The main phone number is 1-800-MEDICARE (1-800-633-4227). TTY users may call 1-877-486-2048.
Medicare Advantage plan members can call the Medicare Drug Integrity Contractor, or MEDIC, at 1-877-7SAFERX (1-877-772-3379).
Be sure to have the following information:
• Your name and Medicare number
• Provider’s name and identifying info
• The service or item in question and when it was provided
• Payment amount approved/paid by Medicare
• Date on your MSN or claim
Learn More: Why Does Medicare Have a “Donut Hole” and How Does It Work?
People Also Read: Most Common Medicare Mistakes
