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Medicare Fraud Prevention: How to Protect Yourself and Your Benefits

Medicare, provides healthcare coverage for millions of Americans, unfortunately, it also attracts fraudulent activities aimed at exploiting beneficiaries and the system. Medicare fraud can result in financial losses, compromised personal information, and disruptions in healthcare services. In this post, we’ll explore what Medicare fraud entails, common scams to watch out for, and essential tips for protecting yourself and your Medicare benefits from fraudulent activities.

Understanding Medicare Fraud

Medicare fraud occurs when individuals or entities intentionally deceive Medicare for financial gain. Fraudulent activities can take various forms, including:

  • Billing for Services Not Provided

    Submitting claims for healthcare services or supplies that were never provided to beneficiaries.

  • Upcoding and Unbundling

    Inflating bills by using incorrect billing codes or billing separately for services that should be billed together.

  • Kickbacks and Referral Schemes

    Offering or receiving kickbacks or incentives in exchange for referrals for Medicare-covered services.

  • Identity Theft

    Stealing beneficiaries’ personal information to fraudulently bill Medicare for services or obtain prescription drugs.

Common Medicare Fraud Schemes

  • Telephone Scams

    Fraudsters may call beneficiaries posing as Medicare representatives or healthcare providers, attempting to obtain personal information or sell fake medical products or services.

  • Identity Theft

    Scammers may use stolen Medicare numbers to bill Medicare for services beneficiaries didn’t receive, resulting in erroneous charges and potential loss of benefits.

  • Medical Equipment Fraud

    Fraudulent suppliers may offer unnecessary medical equipment to beneficiaries or bill Medicare for equipment never received, exploiting coverage for durable medical equipment.

  • Prescription Drug Fraud

    Scammers may offer counterfeit or illegitimate prescription drugs at discounted prices, putting beneficiaries’ health at risk and defrauding Medicare for prescription drug costs.

Tips for Medicare Fraud Prevention

  • Protect Your Medicare Number

    Safeguard your Medicare card and number as you would your credit card or Social Security number. Only share your Medicare number with trusted healthcare providers.

  • Be Skeptical of Unsolicited Offers

    Be cautious of unsolicited phone calls, emails, or mailings offering free medical equipment, supplies, or services. Verify the legitimacy of offers with Medicare or your healthcare provider.

  • Review Your Medicare Summary Notices and Explanation of Benefits

    Regularly review your Medicare Summary Notices and Explanation of Benefits statements to ensure that the services listed were received and that you’re not being billed for any unauthorized or fraudulent charges.

  • Report Suspected Fraud

    If you suspect Medicare fraud or have concerns about a billing error, report it immediately to the appropriate authorities. Contact Medicare’s fraud hotline at 1-800-MEDICARE (1-800-633-4227) or the Office of the Inspector General.

  • Stay Informed

    Stay informed about common Medicare scams and fraud schemes by regularly checking updates from Medicare, the OIG, and other reputable sources. Knowledge is your best defense against fraud.

Protecting yourself from Medicare fraud requires vigilance, awareness, and proactive steps to safeguard your personal information and benefits. By understanding what Medicare fraud entails, recognizing common scams, and following essential prevention tips, you can reduce the risk of falling victim to fraudulent activities and help protect the integrity of the Medicare program for all beneficiaries. Remember, if something seems too good to be true or raises suspicions, it’s essential to verify the legitimacy of offers and report any suspected fraud promptly. Your diligence can make a difference in combating Medicare fraud and preserving the integrity of healthcare services for everyone.

We do not offer every plan available in your area. Currently we represent AETNA, United Healthcare organizations which offer AETNA: MA and PDP and United Healthcare: MA, PDP, CSNP, DSNP products in your area. Please contact Medicare. gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all your options.

Not affiliated with or endorsed by the government or Federal Medicare Program. J G Petit Insurance sales agents not affiliated with the government.

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John Petit

John has a degree in Finance, a Master’s degree in Management, and is licensed to offer insurance products, financial products such as mutual funds and retirement plans.

Published March 11, 2024. Updated May 28, 2024

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