Protect yourself against Medicare Scams & Fraud

Medicare fraud is a serious issue that affects people across the nation. Falling victim to fraud can be expensive and compromise your health care benefits down the road. Discover the common signs of a Medicare scam, ways to avoid them, and learn how to report a deceitful situation.

What Medicare Representatives Can’t Do

To stop Medicare fraud, it helps to start with what representatives are NOT allowed to do. If you encounter someone who doesn’t follow the federal guidelines for Medicare health plans, you’ll know that you’re in the company of a fraudster. Agents and people representing Medicare plans can’t do the following:

  • Arrive at your home uninvited for the purpose of selling a Medicare plan or product
  • Enroll you in a plan if you didn’t request enrollment
  • Make you listen to a Medicare sales pitch in certain health care environments, such as an exam room or a pharmacy counter

If you want to learn more about Medicare options and Medicare Supplement Insurance policies, you can make an appointment with an agent. The representative can tell you about the plans you agreed to discuss, offer you plan materials, and provide you with an enrollment form. Agents can’t:

  • Charge you an enrollment processing fee beyond that of the specific carrier. These average around $15-$25.
  • Pressure you to choose a certain plan
  • Rank plans with terms like “the best” to guide you toward their plan.

How to Protect Yourself From Medicare Fraud

Medicare fraud can quickly develop into a major problem. If you’re vigilant, it’s relatively easy to prevent. These simple steps go a long way toward Medicare fraud prevention.

  • Personal Information: Keep your personal information private. Never share your Medicare number, Social Security number, or credit card number unless you’re sure the person on the other end of the phone is a representative of your plan. Always be wary of allowing anyone who isn’t your doctor or insurance carrier to review your medical records.
  • Billing Statements: Check your Medicare billing statements carefully. Maintain complete records of all of the health care services, medical supplies and equipment, and prescription drugs you receive. recommends keeping a calendar to track your doctor appointments and the tests and services you’ve received. Be sure to track hospital admission and discharge dates as well as relevant diagnoses.
  • Suspicious Activity: When you receive your quarterly Medicare Summary Notice (MSN), compare it against your documentation. If you notice a double charge or a charge for something your health care provider didn’t order, don’t let it slide. You might not think it’s worth your time to fight a few dollars on your MSN, but fraudulent charges can add up over time. Always be on the alert for suspicious activity, and ask your health care provider if you don’t understand a charge.

How to Report Medicare Fraud

If you suspect fraud on the part of a Medicare agent, a health care provider, or an unknown party, get to the source of the problem right away. If you notice a billing discrepancy, try calling your health care provider first to get more information about the charge. The charge may be legitimate but categorized as something that’s unfamiliar to you, or it could be an unintentional billing error.

If you believe that you’re a victim of fraud, call 1-800-MEDICARE or report the case to the Office of the Inspector General. Make sure you have the following information on hand to report fraud:

  • Your Medicare number
  • The date of the MSN
  • The date the service was provided or the item was supplied
  • The amount of the service or supply in question
  • The health care provider’s name and contact information
  • Why you don’t think Medicare should have paid for the service or supply

In some cases, you’ll get more than just peace of mind when you report a scam. You could receive a reward of up to $1,000 if you report a specific instance of fraud that leads to the recovery of at least $100 of Medicare funds.

Don’t let your family members or friends fall victim to Medicare scams. Share this article to prevent Medicare fraud cases and help your loved ones keep their personal information safe and secure.

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