By following the tips below to prevent Medicare Fraud, you can be the first line of defense in protecting you or your loved one’s finances and benefits.
Tips to Protect Against Medicare Fraud
- Protect your Insurance and Medicare Cards just like you do your bank card, except people you know and trust, such as your healthcare provider, insurance company, Medicare or community agencies that work with Medicare, such as Iowa Senior Medicare Patrol (SMP) and Senior Health Insurance Information Program (SHIIP). Keep your Medicare card in a safe place.
- Report a lost or stolen membership card to your insurance company or Medicare right away. Click here to learn more about replacing your Medicare Card.
- Shred all documents with personal information before throwing them away.
- Be suspicious of anyone offering you free medical equipment or services by requesting your Medicare number, especially over the phone, on T.V., in junk mail, on-line or in-person. If you need medical equipment or services, ask your doctor.
- Don't allow anyone to borrow or pay you to use your Medicare card or personal information. They could use your benefits and leave wrong medical information in your health record.
- If individuals call and ask for your insurance or Medicare information, hang up. Beware if someone seems to know part of your Medicare number and ask you to give out the rest. Be suspicious if they say they represent Medicare. Remember: Medicare and other government agencies will never call you to ask you for your Medicare number; Medicare already knows your number. However, if you called Medicare first, they may ask for your Medicare number to verify your identity.
- Don't do business with salespersons who offer "free" products or say-they can help you "get around" Medicare rules. They may be trying to use your Medicare number to bill Medicare for the "free" product, or they may be trying to steal your Medicare number to commit fraud.
- Make sure you understand what's in a document before you sign it. If you need an interpreter - language or sign - ask for one. Never sign a blank Medicare or insurance form.
- Pay attention to your gut feeling about people who are trying to sell you something or get personal information from you. Remember, if an offer sounds too good to be true, it may be a scam.
Tips to Detect Medicare Fraud
- Always review medical bills, Explanation of Benefits statements, and Medicare Summary Notices. Be alert for unexpected or unexplained charges for medical services, prescription drugs, supplies, or equipment.
- A Medicare Summary Notice (MSN) is a notice that Medicare sends you that shows they paid the provider on your behalf. It is your responsibility to make certain that the charges were correct. Things to look for:
- Duplicate payments for the same service
- Dates of service on the MSN match the dates you received the services
- Items or services you do to have a record of having received.
- Billings for medical equipment or services that your doctor did not order.
- If you have Original Medicare, set up your private account on MyMedicare.gov for 24/7 access to your claims history.
- Keep a journal and save your receipts. Compare this information to your medical statements. Are the dates correct? Did you receive the services or supplies? Do you recognize the provider's name? Call SHIIP—SMP to get a FREE Medicare Claims Folder to track your services and payments and keep your receipts.
- If Medicare denies a claim for a service because you supposedly already used the benefit or because it wasn't medically necessary, perhaps a wrong diagnosis code or wrong Medicare number was entered on the claim, or maybe your Medicare number was stolen.
- If a collection agency or debt collector contacts you for an unpaid medical bill you can't explain, someone may have used your Medicare number.
- If an insurance company refused to cover you because of a condition you don't have, wrong information could be in your medical records. Ask you healthcare providers for a copy of your medical records. Also, find out who else received your health information. Look for information about health conditions, surgeries, medications, and allergies that should or should not be in your medical records. Make sure errors are corrected. Wrong information in your medical records could be life threatening.
- Each year, ask your insurance company to send you a list of all benefits they paid. Check for services you did not receive. Thieves sometimes change a victim's contact information when obtaining services, so benefit payments and reports made to your plan number may not come to you.
- Reading your medical statements can be tough. SHIIP--SMP counselors offer free, confidential consultations to review your Medicare Summary Notices and Explanation of Benefits.
Reporting Medicare Fraud
If you suspect fraud, errors or abuse, make an appointment with a SHIIP-SMP counselor. Click the link below to find a SHIIP-SMP near you.