Medicare fraud can be big business for fraudsters and a big problem for taxpayers. And emergent health crises, such as the one around COVID-19, may create environments prime for scammers to take advantage of unsuspecting people.
Medicare fraud can lead to big financial burdens
Stolen Medicare numbers may become valuable loot for criminals. These numbers can be used to bill Medicare for services and supplies that were never provided or received. The reimbursements are then pocketed.
And who pays? We all do. The more that is paid out in false claims, the less there may be to pay for legitimate health care needs. The long-term result can be higher premiums and stricter rules around eligibility for supplies and services.
Tips to avoid Medicare fraud
Follow these 6 tips to help avoid Medicare fraud.
1. Keep your Medicare card close
Treat your Medicare card as you would your Social Security card or a credit card – keep it safe and never leave it out in the open.
2. Guard your Medicare number
Never give your Medicare number to a stranger over the phone. Do not give your card or number to anyone except your doctor or another authorized Medicare provider or authorized agent.
3. Watch out for bogus Medicare plans
Criminals may try to entice you with phony Medicare plans, products, benefits and services. The real aim is to get your Medicare number. Check directly with the plan provider or use the Plan Finder at Medicare.gov to verify any plan you are considering. If it’s not there, it may not be legitimate.
4. Beware “FREE” health care services or products
Just walk away if someone asks for your Medicare information in exchange for free medical services or products. If it’s free, they have no need for your insurance information. This may be another scam to get your Medicare number. (Keep in mind that a legitimate insurance agent or company representative will need your Medicare number if you choose to sign up for Medicare supplement insurance plan, a Medicare Advantage plan or a Medicare prescription drug plan.)
5. Avoid deceptive door-to-door salespeople
Do not accept medical supplies or information from a door-to-door salesperson. And remember that neither Medicare nor Medicaid sends representatives to people’s homes to sell products or services. In addition, insurance agents may not come to your home unless you have asked them to.
6. Scour your Medicare statements
Medicare or your private insurance provider sends you claims summary statements detailing the health care you have received. Read them carefully. It’s important to verify that you received all the services and products that appear. Report anything that you suspect may be an error.
How to report Medicare fraud
The first thing to do when you suspect fraud is to check with your Medicare plan provider. It may be a simple mistake or misunderstanding.
If you still think that the charge to Medicare is for a service or supply you did not receive, then you can call the Medicare helpline to report it (1-800-MEDICARE or 1-800-633-4227, TTY 1-877-486-2048, 24 hours a day, seven days a week). Medicare.gov also offers some more tips for preventing fraud online.
You can also call the Senior Medicare Patrol (SMP) office in your state. SMP workers and volunteers can help you determine if you have been a victim of fraud. If you have, they will forward your complaint to government investigators.