Dear Marci,
I recently found out that my doctor billed Medicare for several medical tests that I never actually received. What steps can I take going forward to protect myself from Medicare fraud?
– Grace (Anchorage, AK)
Dear Grace,
Medicare fraud happens when doctors, providers, or individuals deceive Medicare into paying more than it should, or paying for services when it should not. This is against the law, and it can put the health and wellbeing of Medicare beneficiaries at risk.
There are steps that you can take to protect yourself from Medicare fraud and ensure that you still receive appropriate medical care. Here are some important tips:
1. Protect your medical information: This includes your Medicare number, Social Security number, and medical information. Only give this information to your doctors and health care providers. Be careful about giving your personal information to people who offer free services or other incentives in return for your Medicare number or Social Security number. Similarly, if people who are not medical professionals want to see your medical records or recommend medical services, do not let them. Social Security and Medicare will never call you to ask you for personal information, so be wary of scammers posing as government agencies or banks trying to request this information.
2. Do not accept services that you do not need: Some dishonest providers might pressure you into receiving tests or services that are not medically necessary. Billing Medicare for unnecessary services and equipment is a type of Medicare fraud. You can report pressure from health care providers to receive extra services.
3. Review your Medicare Summary Notices (MSN)or Explanation of Benefits (EOB): Reviewing these documents can help you to verify that you actually received the services listed. For example, if your Explanation of Benefits from your Part D plan indicates that the plan paid for a medication you didn’t receive, this could be a sign of fraud. Keep in mind that it can be difficult to tell whether charges are legitimate if you received services from several doctors around the same time or you take many medications. One way to keep track is to use a health care journal to record all medical services and items you receive. You can compare your notes to notices above to help you detect possible fraud.
4. Verify information that you receive aboutMedicare Advantage and Part D plans: You should verify everything that a plan broker tells you regarding a Medicare Advantage plan. For example, if a broker tells you that your doctor is in the plan’s network, call your doctor to confirm this. If you feel that you are receivingfalse information from a Medicare Advantage plan or Part D plan representative, you can contact 800-Medicare to verify a plan’s information. Medicare Advantage plans must follow specific guidelines when marketing their plans, and cannot provide you misleading or false information to get you to enroll in their plan.
If you receive a suspicious or confusing MSN or EOB, contact your provider or pharmacy first to ask for an explanation. Medical claims can be complicated to read, and reviewing them with your provider or pharmacy might reveal that the charges were legitimate or that a billing error was to blame.
If you are still unsatisfied with the answer you receive, or if you suspect fraud, you should report the issue. It is helpful to have as many details as possible when reporting suspected fraud, such as specific names, locations, and times. If you have Original Medicare, you can call 800-Medicare to report the suspected fraud. If you have a Medicare Advantage plan, you can call your plan directly. Regardless of whether you have Original Medicare or a Medicare Advantage plan, you can contact the Office of the Inspector General (OIG) at 800-447-8477. When Medicare investigates the potential fraud, your name will not be used if you do not want it to be. In many cases, Medicare will be unable to confirm the occurrence of fraud without your help.
-Marci