Don’t Become a Medicare Fraud Victim

| August 30, 2013 | 0 Comments | Email This Post Email This Post


Fraud, waste and abuse cost the Medicare program $48 billion in 2010, affecting one in 10 claims, according to the Government Accountability Office (GAO). The Medicare industry has begun incorporating the latest technology from the banking industry to catch fraud, waste and abuse earlier. In the same way, if you have ever gone on a spending spree only to get a call from your credit card company that same day to make sure your card wasn’t stolen?  Health plans have begun detecting claims that might be out of the ordinary to stop fraud before it happens.

 Don’t fall for illegitimate offers

 Many health care thieves target their victims with offers of cash or other rewards. For example, someone may offer you cash for the use of your insurance or drug card or for switching to another plan. This is illegal. Don’t do it. Additionally, be suspicious of anyone who offers you free medical equipment or services and asks for your card number. Remember the old adage: “If it sounds too good to be true, then it probably is.”

 Make sure you get all your medication

 When you visit your pharmacy, make sure that you get all of your medicine. That means if your doctor ordered 30 pills, then you should get all 30 — and not just 25. Also make sure you get the drug the doctor ordered, and not another, unless your physician allowed for generic substitutions.

 Check your receipt

 When you go to the grocery store, chances are you check your receipt to make sure you weren’t overcharged. Medicare members get a receipt, too. It’s called an Explanation of Benefits (EOB). Always check the services and drugs listed on your EOB to make sure you actually received them. Large criminal operations have been brought down thanks largely to alert individuals who caught fraudulent charges on their statements. Examples of fraud include being billed for services you did not receive, being charged by a provider you did not see or being billed for dates you were not there. Always call your provider first to make sure the error wasn’t an honest mistake. In most cases, you also can go to your health plan’s web site to view your claims history.

 Report suspect charges immediately

 If you think you have been the victim of Medicare fraud, you should report it immediately by calling Medicare 24 hours a day, 7 days a week, at 1-800-633-4227 (1-800-MEDICARE) TTY: 1-877-486-2048, visiting Medicare’s web site at or contacting your health plan at the number on your ID card.

But even with these technologies, the frontline of defense against Medicare fraud is still the individual member. In addition to wasting taxpayer dollars, medical fraud can disrupt members’ lives, damage their credit ratings and corrupt their health history.


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