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Medicare Fraud Prevention

Did you know that in 2016, the federal government spent $588 billion, or about 15% of the total federal budget, on the Medicare program (according to the Henry Kaiser Foundation)? What many people don’t know is that conservative estimates of $60 billion, or 10%, of this spending is lost to fraud, abuse, and errors. This leads to many challenges, both for the long-term viability of the program, and the physical and financial security of people with Medicare. It is important that you, as a beneficiary or as a caregiver of a person with Medicare, understand Medicare fraud and what you can do to prevent it. Even though most medical providers are honest and want the best care for their patients, Medicare fraud occurs and can happen to you. As part of the Centers for Medicare and Medicaid Services’ (CMS) fraud prevention efforts, new Medicare cards that do not contain Social Security numbers will be mailed to all people with Medicare starting in April 2018. This article provides tips on preventing health care fraud and what you need to know about the new Medicare cards.

Because Medicare is a very complex system, it is easy for innocent human errors to be made, such as duplicate claims, incorrect billing codes, or submitting a claim on the wrong Medicare account. Fraud, however, is different from human error because it involves knowingly and willfully billing Medicare to obtain inappropriate payments. Some examples include billing for services or supplies that were not provided, prescribing unnecessary tests and services, or misrepresenting a diagnosis to justify a payment. Fraud may cause you to end up with higher out of pocket costs. Fraud may also negatively impact your health, in part by decreasing the quality of care you receive. In addition, you could receive unnecessary and potentially harmful care from unscrupulous providers who misdiagnose beneficiaries to justify a treatment. Conversely, you could be denied necessary treatment or equipment. For instance, under the current system, you are entitled to one wellness visit every 12 months. If this benefit has been fraudulently coded by a provider at a so called “free community event” or urgent care center, Medicare will deny coverage when the visit is actually needed at your doctor’s office, leaving you with an unexpected bill.

So, what can you do to protect yourself from fraud, errors and abuse?  Luckily, there are some simple steps that every person with Medicare and their loved ones can do to Prevent, Detect, and Report Medicare fraud. 

New Medicare ID cards are coming! All Medicare beneficiaries will receive a NEW Medicare card with one major difference – a new Medicare number, which is not based onMedicare Card a Social Security number, will be on the card. Because of increased concerns about identity theft and other safety reasons, Social Security numbers will be replaced by a random, 11-digit number that is unique to you, with no identifying information. The new Medicare card will be sent to you in the mail by the Centers for Medicare and Medicaid Services (CMS).  If you have moved, be sure to update your address with Social Security at 1-800-772-1213 or at my Social Security at

Quick Tips to Remember:

Article provided by Senior Medicare Patrol


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