Don’t Be a Target of Health Care Fraud

Joe was almost the victim of fraud. Joe has Medicare. One evening he received a phone call from a woman who identified herself as a Medicare representative. She informed him that she could send him free diabetic testing supplies and a new blood pressure monitor. Joe pays $100 a month for his testing supplies, so he eagerly agreed. When the woman said she could sign him up over the phone using his Medicare number and bank account information he gave them to her.

After sleeping on it, Joe thought he had made a mistake by giving out his personal information. He contacted his local Senior Medicare Patrol (SMP). The SMP helped Joe contact his bank, close his account and report the crime to the police and Medicare.
Protecting your personal information is the best line of defense in the fight against healthcare fraud and abuse. Every day, consumers like Joe get ripped off by scam artists, causing Medicare and Medicaid to lose close to $60 billion each year.

What is Medicare fraud?
Medicare and Medicaid fraud generally involve deliberately billing for services that were not received, or billing for a service at a higher rate than is justified. Medicare abuse occurs when providers supply services or products that are not medically necessary or do not meet professional standards.

Examples of fraud and abuse

Billing for services and supplies that were not provided
“Upcoding” – improper coding to obtain a higher payment
Performing unnecessary or excessive x-rays and lab tests; claims for services that are not medically necessary
Billing for excessive medical supplies
Using another person’s Medicare card to obtain medical care, supplies or equipment
Tricking senior center participants into giving up their personal information (including Medicare numbers) on “sign-in” sheets
Luring beneficiaries into providing their Medicare number for “free” services, then billing Medicare for equipment or services not delivered
Paying beneficiaries to receive service from a particular provider or company (kickbacks)

Ways to Take an Active Role in Protecting Yourself

Remember, Medicare doesn’t sell anything.
Rip up or shred your Medicare papers and other important documents before throwing them away. People go through trash.
Don’t leave mail in your mailbox for more than one day.
Never show anyone your medical or prescription records without first talking to your doctor or pharmacist.
Never provide a salesperson with your doctor’s name or number.
If someone offers to buy your Medicare number, don’t do it.
If someone comes to your door and says they are from Medicare and they need your Medicare number – shut the door!
Visit only your personal doctor, hospital or clinic for medical help. Trust only them to make referrals for special equipment, services, or medicine.
Always read your Medicare Summary Notice (MSN). This is the piece of mail stamped, “This is Not a Bill” that comes in after you get medical care. Look for three things on your MSN:
- Charges for something you didn’t get
- Billing for the same thing twice
- Services that were not ordered by your doctor

Editorial provided by Indiana Association of Area Agencies on Aging.