Identifying and fighting Medicare fraud
June 1, 2022 | View PDF
This June, we acknowledge 25 years of progress helping each other in preventing Medicare fraud. We appreciate your efforts, both for yourself, your fellow Alaskans, and all who benefit from Medicare. As your local Senior Medicare Patrol (SMP), we are ready to provide you with the information to protect yourself from Medicare fraud, errors and abuse. If you have any questions or concerns, please call the State of Alaska’s Medicare Information Office (MIO) to speak with any of our certified counselors.
The costs of fraud
Medicare loses an estimated $60 billion each year due to fraud, errors and abuse. Every day, issues related to these concerning matters affect people across the country, often costing them money, time and well-being. Medicare-related errors contribute to this annual loss even though errors can be honest health care billing mistakes. However, a pattern of errors committed by a physician or provider could be a red flag of potential fraud or abuse if not corrected. When people steal from Medicare, it hurts us all and is big business for criminals. Some common examples of fraud or abuse could include:
Charging for services or supplies that were not provided.
Misrepresenting a diagnosis, a person’s identity, the service provided, or other facts to justify payment; or
Prescribing or providing excessive or unnecessary tests and services.
Medicare ID protection
Falling prey to consumer scams or health care fraud may mean that your Medicare number has been “compromised” as a result of medical identity theft. Theft from Medicare leaves less available funds for those needing services now as well as those needing Medicare in the future.
One of the best things to do is to protect your Medicare card in the same way that you protect your Social Security card. Both of these numbers can be used to commit fraud, so keep them safe. Keep a record of your medical appointments, then periodically review your medical insurance claims on your Medicare Summary Notice (MSN) or Explanation of Benefits (EOB); these are normally mailed to you or you can review claims online. Look for services, products or equipment that you or your doctor did not order. If you find items of concern, call the doctor or company in question and ask them about potential mistakes. A pamphlet, “My Health Care Tracker”, is available to help you; these are available by calling the Medicare Information Office and requesting one be mailed to you.
Caring for each other
Family members, caregivers and health care providers each can help in preventing fraudulent practices. Be on the lookout for items such as durable medical equipment (like boxes of knee braces) lying around the house that may have been shipped to the beneficiary without their or their doctor’s approval.
Remind your client or loved one to never give out their Medicare number or other personal information over the phone. Encourage them to check their Medicare statements for fraud, errors or abuse. Help your loved ones create a Medicare.gov account to access their Medicare claims online or remind them to open and review their statements when they come in the mail every three months. You can also register their phone number on “do not call” lists and go to http://www.optoutprescreen.com to opt out of mailings. Health care providers help by talking to patients about health care-related scams such as those related to durable medical equipment and genetic testing schemes.
Remind your loved ones that products and services should only be ordered by physicians they regularly see. Needed medical items should never be ordered through TV ads or unsolicited calls. Lastly, as a community, help by looking out for your older neighbors. When in public, be aware of older individuals purchasing gift cards in large amounts. If you overhear someone talking about Medicare, do not be afraid to offer information about the Medicare Information Office or your local Aging and Disability Resource Center (ADRC). Encourage those you know to talk to a trusted source about their Medicare questions and tell your neighbors about the most recent Medicare scams. Consider volunteering with us!
For answers to any Medicare related questions, please feel free to contact the State of Alaska’s Medicare Information Office at 800-478-6065 or 907-269-3680; our office is also known as the State Health Insurance Assistance Program (SHIP), the Senior Medicare Patrol (SMP), and the Medicare Improvements for Patients and Providers (MIPPA) program.
Sean McPhilamy is a volunteer and Certified Medicare Counselor at the Alaska Medicare Information Office.