Preventing Medicare Fraud
The Pennsylvania Senior Medicare Patrol
Over $48 billion dollars are lost to Medicare fraud and abuse each year. Money lost to fraud means increased premiums for beneficiaries, increased taxes for all of us, and less money available for programs that assist caregivers. In addition to the financial cost, there is a human cost. Health care fraud diminishes the quality of care received by older adults and can result in the denial of medically necessary treatment.
The U.S. Administration on Aging developed the Senior Medicare Patrol (SMP) to help consumers understand more about health care fraud. Retired Medicare beneficiaries teach their peers about fraud and what they can do about it. The message is simple: Protect your personal information, know how to Detect fraud, and know where to Report fraud. CARIE, The Center for Advocacy for the Rights and Interests of the Elderly, a private, non-profit organization dedicated to improving the well-being, rights and autonomy of older adults, began the Pennsylvania SMP in 1997. Through partnerships with AARP, APPRISE (PA’s health insurance counseling program), and RSVP, the PA-SMP has informed thousands about Medicare fraud prevention across Pennsylvania.
What is Medicare Fraud?
Fraud occurs when an individual or organization deliberately deceives others in order to gain some sort of unauthorized benefit. Medicare fraud generally involves billing for services that were never rendered or billing for a service at a higher rate than is actually justified. It is important to note that most health care professionals are honest, trustworthy, and responsible. The goal of this initiative is to weed out the few health care providers who operate by using Medicare as a pipeline to personal profit.
Examples of Fraud
- Billing for services or supplies never provided
- A woman finds a charge on her Medicare Summary Notice for a $5,000 scooter that she never received.
- Double billing or over billing for a service or supplies
- A man visits his doctor one time but Medicare is billed and pays for two visits
- Incorrectly reporting diagnoses, procedures, medications, or equipment to get a higher payment
- A Podiatrist clips patients’ toenails and bills it as a toenail extraction
What Can You Do? Protect, Detect, Report
PROTECT
- Treat your Medicare card like it is a credit card. Remember, your Medicare number is your social security number. Medicare fraud and identity theft are two sides of the same coin.
- Never give your Medicare number in exchange for “free” services or products. Unscrupulous providers will use your numbers to get reimbursed for products or services they never delivered.
- If someone calls you or comes to your door claiming to be from Medicare, remember that they never send representatives to your home. Medicare does not call you and ask for personal information.
- Never accept durable medical equipment or supplies from someone who calls you or comes to your door. If you need a piece of equipment, call your doctor first. If Medicare pays for something you don’t need now, it may not pay for something you actually do need in the future.
DETECT
- Use a health care journal to record all of your doctor’s appointments and what tests or X-rays are conducted.
- Check your quarterly Medicare Summary Notice and other medical statements carefully to make sure the services and details are correct. Compare your statements with your health care journal and make sure the charges match what you actually received.
- If you spend time in a hospital, make sure the admission date, discharge date, and services listed on your statement are correct.
REPORT
- If you suspect Medicare fraud or abuse, call the Pennsylvania Senior Medicare Patrol at CARIE at 1-800-356-3606.
PA-SMP volunteers are available to speak to your group about Medicare Fraud. To schedule a free presentation, or, to learn more about volunteering, please call Sue Anthony at 412-464-1300. To learn more about the PA-SMP, please visit us online at www.carie.org/smp, or on Facebook: www.facebook.com/pennsylvaniasmp