Licensed Insurance Agents: 888-323-1149 TTY: 711
Mon - Fri, 8am - 8pm ET

Medicare Fraud and How to Protect Yourself

October 6, 2016

Medicare fraud encompasses various types of deception. Occurring at many levels, it can be perpetrated by patients, doctors, and other individuals who prey on the unsuspecting. Medicare fraud is generally defined as making false claims and/or manipulating material facts for financial gain, although it can also happen when Medicare beneficiaries are fooled into giving their personal information.

The Centers for Medicare and Medicaid Services (CMS) define Medicare fraud as:

  • Knowingly billing for services that were not furnished and/or supplies not provided, including billing Medicare for appointments that the patient failed to keep.
  • Knowingly altering claims forms and/or receipts to receive a higher payment amount.

It may be easy to dismiss this type of fraud, thinking that it does not impact you personally, but the more financial waste that occurs in the system, the more expensive Medicare becomes for everyone. For example, according to a 2015 CMS report, the Obama Administration’s Justice Department has  recovered over $15 billion in health-care fraud  cases since 2009. As such, the Medicare program has made the elimination of fraud, waste, and abuse a top priority. CMS uses tactics designed not just to catch people who have committed Medicare fraud, but also to prevent it.

There are some simple ways that you can do your part to keep an eye out for suspicious Medicare charges and also protect yourself from fraud.

  • Document your doctor appointments: Make a note of your appointment dates, and save any statements that you may receive from your doctor.
  • Review your Medicare claims: When you receive your Medicare statement in the mail, check the claim to make sure that Medicare was not billed for a service you did not receive.
  • Report suspected fraud: If you think that your Medicare number has been used for fraudulent billing, call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048. Representatives are available 24 hours a day, seven days a week. If you suspect that your personal information has been compromised by giving it to someone erroneously, contact the Federal Trade Commission‘s ID Theft Hotline at 1-877-438-4338 from 9AM to 8PM EST.
  • Do not give your Medicare number to anyone who shouldn’t have it: Don’t give this information to anyone other than your doctor and/or health care provider.

Preventing individual fraud and identity theft

At the individual level, Medicare fraud occurs when you are contacted by someone who tries tricking you into surrendering your personal information, such as your Medicare, Social Security, and/or checking account numbers. They might claim that you have to give your information for your Medicare card to be renewed. They may also target you if you are just about to reach the Medicare-eligibility age, claiming to help you enroll in a Medicare plan in exchange for your personal information.

These con artists may be convincing. They may be familiar with some of your basic information, like full name and address. They could use this as a means of making you believe they are a legitimate and trustworthy Medicare source. The goal of these scams is to steal your identity, gain access to your bank account, or both.

Fortunately, some basic knowledge can make you less susceptible to these scams. First, Medicare already has your personal information and will never request it when calling you. Also, your red, white, and blue Medicare card does not expire. This means it never has to be renewed. A good way to protect yourself from fraud or identity theft is to refrain from giving out any personal information unless you have initiated the phone call yourself. When in doubt, hang up and call the number listed for the organization in the phone book so you know exactly who you’re contacting.

When you do give out Medicare information, make sure you are only giving it to:

  • Doctors, health care providers, and plans that have been approved by Medicare.
  • Insurers who pay benefits on your behalf.
  • Trusted organizations with Medicare partnerships. For example, your State Health Insurance Assistance Program (SHIP) or the Social Security Administration (SSA).

When seeking the services of a medical supplier, you may want to make sure they are approved by Medicare. You can always check the Medicare Supplier Directory website, where you can review suppliers in your area.