Strategies for Avoiding Medicare Fraud

"The public health emergency provided a chance for fraudsters to tweak and reuse existing schemes," stated an email from a representative for the Centers for Medicare & Medicaid Services, or CMS. CMS has observed bad actors use increased demand for telemedicine, COVID-19 testing, and immunizations to commit identity theft and fraudulent invoicing.

The Office of Inspector General of the Department of Health and Human Services, or HHS-OIG, investigates fraud, waste, and abuse in government healthcare programs such as Medicare. According to the HHS-Spring OIG's 2022 report to Congress, on average, about 9,000 calls were received each month by their fraud hotline from April to September 2021.

One of the numerous steps Medicare recipients may take to protect themselves is to call a fraud hotline. Here are five strategies for avoiding, detecting, and reporting Medicare fraud.

1.Keep Your Medicare Number Safe.

Your Medicare number might be used to steal your identity or submit bogus medical claims if it falls into the wrong hands.

"Our top suggestion is to keep your Medicare number as secure as your Social Security [number] and credit cards," stated a CMS representative. "Only share your Medicare number with trustworthy healthcare doctors or COVID-19 vaccination administrators."

Unexpected callers or visitors that inquire about your Medicare information, especially if they claim to work for Medicare, are suspicious. According to CMS, Medicare will never visit you at home, and a Medicare representative will only ask for your Medicare number over the phone if you have already provided consent.

2. Be Wary Of Freebies

Fraudsters may attempt to obtain your personal information by promising you anything for free in exchange. "That's something to question, or at least run by a medical practitioner you trust," says Isaac Bledsoe, an HHS-OIG criminal investigator.

COVID-19 exams, genetic testing services, or durable medical equipment such as walkers or braces are common instances of free offerings.

3. Avoid Being Persuaded Into Needless Care.

Some methods involve invoicing for costly services that you may not require. Unscrupulous COVID-19 testing centers, for example, may charge up to $500 for needless respiratory pathogen panels. According to a white paper released in January 2022 by the Healthcare Fraud Prevention Partnership, a public-private anti-fraud organization.

If you're unsure, consult with a reputable healthcare practitioner to determine whether a treatment is required and how much it would cost.

4. Examine Your Medical Records

Statements from Medicare clarify what you were billed for, how much Medicare authorized and paid for services, and the maximum amount you may owe to health care providers. Keep an eye out for any unusual goods or charges on these statements.

Request a free "My Health Care Tracker" from your state's Senior Medicare Patrol, or SMP, to help you keep track of everything. SMPs are grant-funded initiatives that provide information and counseling to assist in the fight against Medicare fraud, mistakes, and abuse.

Documents in My Health Care Tracker include sheets for recording information about your health care, instructions for comparing your bills to what was billed, and contact information for entities that can assist with concerns such as mistakes or fraud.

5. Seek Assistance

If you are concerned about possible Medicare fraud, there are free options available to you. Even if you're unsure, don't be afraid to call. Beneficiaries are encouraged to report "Anything that you may think is possibly detrimental or maybe fraudulent".

You can also seek assistance from your Senior Medicare Patrol, who will refer your problem to the proper authorities. For contact information, go to smpresource. org.

You don't need to phone many hotlines if you call the first one. According to Bledsoe, many agencies have prioritized collaboration, so "there's no need to contact nine separate locations to report it nine different ways."

"We can check into [problems] right away and offer a rapid answer of 'yeah, this is something that is not good,'" adds Bledsoe. "We can place your Medicare number on a 'possible vulnerable' list to watch for any future billing that you may not have requested, and we can assist you in the future."