David Sayen
Courtesy: Medicare

Most doctors, pharmacists and other health care providers who work with Medicare are honest. Unfortunately, some are not.
One common form of Medicare fraud is when Medicare is billed for health care services or benefits that you never received. Someone may have gotten access to your Medicare number and submitted a false claim.  In some cases, fraudsters pay Medicare beneficiaries to use their Medicare number.  To prevent this from happening, never share your Medicare number with anyone you do not know and trust.

Medicare fraud costs taxpayers and people with Medicare lots of money each year. So what can you do to help stop it?

When you receive health care services, note those dates on your calendar and save the receipts and statements you get from your doctors and other providers to check for mistakes. If you think you see an error or were billed for services you did not receive, take these steps:

  • • If you are in the Original Medicare program (where the federal government pays health care claims for you), check your monthly “Medicare Summary Notice,” or MSN, to see if the applicable services were billed correctly to Medicare. The services and claims should match, like checks on a bank statement. If there are services, doctors or suppliers that you don’t know and cannot reconcile, there may be a problem.
  • If you’re in a Medicare Advantage private health plan, check the statements you get from your plan.
  • If you are unsure of what services were billed, call the doctor or other supplier and ask for an itemized statement. They should give this to you within 30 days.

In any case, the sooner you spot and report errors in your health care billing, the sooner we can help address and stop the fraud.

How do you report suspected fraud?

If you’ve contacted the health care provider or supplier and you suspect that Medicare is being charged for a service, device or other supplies that you did not receive, or if you don’t recognize the doctor or other providers listed on the claim, here’s what you should do:

  • Call the fraud hotline of the U.S. Department of Health and Human Services, Office of the Inspector General, at 1-800-HHS-TIPS (1-800-447-8477). TTY users should call 1-800-377-4950.
  • Alert Medicare’s customer service team at 1-800-MEDICARE (1-800-633-4227) that you have concerns or questions about information appearing on your MSN.

Did you know that there is a program that works with Medicare beneficiaries around the country to fight fraud? It’s called the Senior Medicare Patrol, or SMP, Program.

The SMP Program educates and empowers people with Medicare and their families to take an active role in detecting and preventing health care fraud and abuse. SMP not only protects people with Medicare — it also helps to preserve Medicare. There’s an SMP Program in every state, the District of Columbia, Guam, U.S. Virgin Islands and Puerto Rico.

You can contact your local SMP Program to get personalized counseling, find out about community events in your area, or even to volunteer. For more information or to find your local SMP Program, visit smpresource.org, or call 1-877-808-2468. You can also call 1-800-MEDICARE.

Keep in mind that every tip counts. Medicare takes all reports of suspected fraud seriously.

When you report fraud, you may not hear the outcome right away. It takes time to investigate and build a case. Be assured that your information is helping us protect Medicare and you.

David Sayen is Medicare’s regional administrator for Hawai‘i, California, Nevada, Arizona and the Pacific Territories. You can always get answers to your Medicare questions by calling 1-800-MEDICARE (1-800-633-4227).


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