4 Effective Tips for Avoiding Medicare Fraud

Medicare fraud usually involves either a patient who knowingly deceives Medicare to receive benefits or when a healthcare provider overcharges Medicare. Identity theft of a patient can lead to fraud as well. Here are a few important tips for avoiding Medicare fraud.

Table of Contents:

1. Identify Medicare Fraud
2. Secure Your Medical Information
3. Protect Your Medicare Number
4. Be Aware of Medicare Marketing Rules
5. Some Common FAQs
   1. What happens in Medicare fraud?
   2. How do you catch Medicare fraud?
   3. What are the red flags for Medicare fraud?
   4. How rampant is Medicare fraud?

Identify Medicare Fraud

Don’t allow yourself to get entangled in a web of Medicare fraud, which may not seem obvious at first. Many fraud cases have unfolded over the past few decades involving hospitals overcharging Medicare for services that were never rendered. Many healthcare organizations have gotten away with it when seniors don’t review all the details of their bills.

Your physician is not supposed to charge you for most preventative services. Make sure the hospital isn’t running up a list of tests that never happened. This technique has been common in Medicare fraud cases. If you see such erroneous charges, notify the billing department. Notify Medicare if your hospital doesn’t respond or address the issue.

Secure Your Medical Information

Another way Medicare fraud can occur is when someone steals your medical information. A thief can use it to impersonate you and get healthcare services or cash. Make sure you only allow medical professionals to access your medical records. Hospitals must follow federal privacy regulations established by HIPAA.

Protect Your Medicare Number

Your Medicare number should be as secret as any of your banking information. Only share your medical history with your doctor or other medical professionals. Be suspicious if anyone besides a healthcare practitioner asks for this information. Don’t fall for the scam of giving up your number to a con artist who says they’ll offer something free in return.

Be Aware of Medicare Marketing Rules

Insurance companies are bound by rules designed to discourage marketing fraud. Less reputable firms might try to exploit seniors who ignore policy details. Make sure you understand a policy’s rules and benefits before signing up. Here are some of the rules insurance companies that promote Medicare Advantage must follow:

• Federal and state telemarketing laws
• Cannot call a sales prospect without first getting permission from them
• May not visit the patient’s home without being invited
• Must not cross-promote different insurance products in one appointment
• Not allowed to contact patients on behalf of Medicare

Additionally, healthcare organizations cannot engage in bribery or receive kickbacks from other entities to prescribe or promote certain medical products. Ultimately, committing Medicare fraud is cheating the government, which can lead to criminal charges, fines, and jail time.

Medicare frauds usually result in higher medical costs and taxes for everyone. Therefore, it’s important to make sure all your communication with Medicare is accurate and honest. Contact us here at Medicare Advisors for answers to your questions about Medicare.

Some Common FAQs

What happens in Medicare fraud?

Medicare fraud is when doctors, pharmacists and other health care providers knowingly and purposely claim reimbursement for which they are not entitled, thereby illegitimately collecting money from Medicare. Medicare fraud can result in:

• Higher health care costs and taxes for everyone
• Reduced quality of care and access to services for beneficiaries
• Potential harm to patients who receive unnecessary or inappropriate treatments
• Legal consequences for the perpetrators, such as fines, penalties, imprisonment or exclusion from Medicare participation

How do you catch Medicare fraud?

There are several ways to catch Medicare fraud, such as:

• Reviewing your Medicare Summary Notice (MSN), Explanation of Benefits (EOB) or claim statements for any errors, discrepancies or charges for services or items you did not receive
• Reporting any suspicious or fraudulent activities to 1-800-MEDICARE (1-800-633-4227), the U.S. Department of Health & Human Services – Office of the Inspector General, or the Investigations Medicare Drug Integrity Contractor (I-MEDIC) depending on the type of fraud
• Protecting your Medicare Number and card from identity theft and unauthorized use
• Becoming familiar with how Medicare uses your personal information and what your rights and responsibilities are as a beneficiary

What are the red flags for Medicare fraud?

Some red flags for Medicare fraud are:

• Providers who offer free services, equipment or tests in exchange for your Medicare Number or card
• Providers who bill Medicare for services or supplies you never received, requested or agreed to
• Providers who perform unnecessary or excessive tests, procedures or treatments that are not related to your condition or diagnosis
• Providers who charge you more than the Medicare-approved amount or ask you to pay in cash
• Providers who use different names, addresses or identification numbers to bill Medicare
• Providers who pressure you to join a Medicare plan that you do not need or want

How rampant is Medicare fraud?

The exact amount of Medicare fraud is difficult to measure, because not all fraud is detected and not all suspicious claims turn out to be fraudulent. However, some estimates suggest that:

• Medicare “improper payments” were $47.9 billion in 2010, but some of these payments later turned out to be valid
• Total Medicare spending was $528 billion in 2010
• The federal government recovered $4.2 billion from health care fraud cases in 2020