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Preventing Medicare Fraud

Every year, Medicare fraud costs billions of dollars to Medicare and tax payers. It is estimated that the total of tax revenue lost to unethical business practices related to Medicare fraud is over $40 billion annually and the number grows year by year. In order to commit fraud, criminals use the information of Medicare users and sometimes people do not even realize it. In this article we will explain what you need to know about it and how you can prevent Medicare fraud.

What is Medicare fraud and how does it work?

Medicare fraud is the claiming of Medicare health care reimbursement to which the claimant is not entitled. In other words, Medicare fraud happens when a patient or doctor abuse from Medicare in order to collect money illegally. There are different types of Medicare fraud but the following are the most common:

  • When the provider knowingly bills Medicare for unnecessary services, procedures or supplies, or services, procedures or supplies that are never performed or provided.
  • When a hospital knowingly bills Medicare for services that cost more than the actual services or supplies provided.
  • When the provider knowingly solicits, receives offers or pays remuneration to induce or reward referrals for items or services reimbursed by Medicare.
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How can detect Medicare fraud?

     If you want to successfully prevent Medicare fraud, first you have to know how to detect it. The best way to do it is by reviewing your Medicare Summary Notice (MSN), in case you have Original Medicare. In this notice there will be all the services and/or supplies that were billed over the last three months. In case you don’t have Original Medicare you will also get a notice with everything specified but the frequency in which you get it may vary. These notices include the total amount billed, the amount Medicare or your insurance company paid to the provider, and the amount you owe, in case there was something not fully covered by your plan.

Compare the notice with the receipts and statements you have from your health providers. In case you see a mistake in the amounts charged or you do not recognize any of the services listed, you can contact you doctor or hospital first so they can fix it or explain why it happened. Sometimes, doctors can make mistakes while billing, like using the wrong medical code on a claim, and they do not even realize they did it. However, if these kinds of things happen often or your health providers cannot explain what is happening, you should contact Medicare and report the situation.

      How do I prevent Medicare fraud?

      The following tips will help you to successfully prevent Medicare fraud:

  • As it was mentioned in another article, new Medicare cards are being sent with a new Medicare number in order to protect your information. Once you get it, destroy the old card and start using the new one.
  • If you’re in a Medicare Advantage Plan (like an HMO or PPO) instead of Original Medicare, your Medicare Advantage Plan ID card is your main card for Medicare and you will still use when you need health care. However, you also may be asked to show your new Medicare card, so you should carry both of them,
  • Take care of your Medicare cards and information the same way you take care of your bank account information and cards.
  • Do not share your Medicare Number or other personal information with anyone who contacts you by phone, email or by approaching you in person. Some scam artists may contact you and try to get information by claiming they are from Medicare.
  • Remember that Medicare will never call you uninvited and ask you to share personal or private information. Scammers may call you under the pretext of getting information to send you the new card. Be aware and call Medicare if this happens to you
  • Only give personal information or your Medicare Number to your doctors, insurers acting on your behalf, pharmacists or trusted people in the community who work with Medicare.



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