Medicare Fraud, by Susan Menkes

Posted by Wes Bradford 
on Jun 03, 2014
 

          Susan Menkes works with the Senior Medicare Patrol (SMP) programs, staffed by senior volunteers and professionals who help Medicare and Medicaid (MediCal) beneficiaries become better health care consumers. These programs are supported by The National Consumer Protection Technical Resource Center created in 2003 with funding from the US government. Susan discussed the dangers facing seniors from healthcare fraud perpetrated by scam artists purporting to be Medicare representatives.
 
  
 
      Protecting your personal information is the best line of defense against healthcare fraud and abuse, which cost the government billions of dollars a year. Ways of protecting your health care benefits include protecting your Medicare and Social Security numbers, and never giving them to a stranger or carrying your Medicare card unless you need it for doctor appointments or pharmacy prescriptions. Record doctor visits, tests and procedures in your personal health care journal or calendar, to compare against future bills or Explanation of Benefits (EOB) to identify mistakes. Save your Medicare Summary Notices and EOBs for reference, and shred them are no longer needed.
 
          Remember, Medicare does not call or visit to sell you anything. A common scam is a phone call from someone claiming to be a Medicare representative and claiming to save you money if you sign up for some service, like the new Medicare Prescription Drug Coverage. They often ask for your Medicare and checking account numbers to sign you up over the phone and ask you to give them your personal information. If you fall for this scam, contact your local SMP and your bank (to close your account), and report the crime to the police and Medicare.
 
          Always review your Medicare Summary Notice and EOB for mistakes, and compare them to your personal health care journal and prescription receipts for mistakes. Look for 3 things on your billing statement:
  • Charges for something you didn’t get,
  • Billing for the same item or service twice, and
  • Services not ordered by your doctor.
          If you have questions about any of this information, call your provider or plan first. (If you’re not comfortable doing this, or are dissatisfied with the response, call your local SMP at 1-877-808-2468.) If you suspect error or fraud, report it immediately to protect others from becoming victims and to help preserve your Medicare benefits. You can access the SMP locator at www.SMPresource.org, and your Medicare account at www.MyMedicare.gov.