Articles
Medicare Fraud Prevention Week
Medicare Fraud Prevention Week focuses on the actions everyone can take to prevent Medicare fraud, errors, and abuse. Learn how you can protect yourself and your loved ones from Medicare fraud by joining us on 6/5 to kick off celebrating this week!
June 2022 marks the 25th anniversary of the Senior Medicare Patrol (SMP) Program and to commemorate this event the SMP is creating a national week focused on Medicare fraud prevention.
Why is This Week Important?
Medicare loses an estimated $60 billion each year due to fraud, errors, and abuse. Every day, issues related to these concerning matters affect people across the country, often costing them money, time, and well-being. Medicare-related errors contribute to this annual loss even though errors can be honest health care billing mistakes. However, a pattern of errors committed by a physician or provider could be considered a red flag of potential fraud or abuse if not corrected.
When people steal from Medicare, it hurts us all and is big business for criminals. Some common examples of fraud or abuse could include:
- Charging for services or supplies that were not provided
- Misrepresenting a diagnosis, a person’s identity, the service provided, or other facts to justify payment
- Prescribing or providing excessive or unnecessary tests and services
Falling prey to consumer scams or health care fraud may mean that your Medicare number has been “compromised” as a result of medical identity theft. Theft from Medicare leaves less available funds for those needing services now as well as those needing Medicare in the future.
How to Take Part in the Week
The most effective way to stop fraud from occurring is to prevent it in the first place. Educating yourself and your loved ones on how to prevent Medicare fraud, errors, and abuse is the best place to start.
If you are a Medicare beneficiary, kick off the week on 6/5 by learning how to read your Medicare statements! Read your Medicare Summary Notice (MSN) or Explanation of Benefits (EOB) in the paper form that is mailed to you or go online to Medicare.gov and review claims digitally.
Remember the three steps from the SMP: Prevent, Detect, Report!
- Prevent: Learn how to read your MSN by watching this video, How to Read Your Medicare Summary Notice (MSN). You can also call your SMP or go to their website to learn how to best protect yourself and your loved ones from health care fraud, errors, or abuse. Find your SMP by using the state locator.
- Detect: When reviewing your MSN or EOB, look for services, products, or equipment you didn’t receive, double charges, or items your doctor didn’t order.
- Request and use a My Health Care Tracker from your SMP to compare appointment information you recorded with what is printed in your MSNs and/or EOBs.
- If you find items of concern, call the doctor or company in question and ask them about potential mistakes. Call your insurance company if you still have questions.
- Report: Call or email your local SMP if you believe that you have experienced health care fraud, errors, or abuse or if you would like to request a My Health Care Tracker.
Caregivers, help by educating yourself and your client or loved one on how to prevent and detect health care fraud, errors, and abuse. Be on the lookout for items such as durable medical equipment (like boxes of knee braces) lying around the house that may have been shipped to the beneficiary without their or their doctor’s approval. Remind your client or loved one to never give out their Medicare number or other personal information over the phone.
Families, help by talking to your loved ones about protecting their Medicare number just as they would a credit card number. Encourage them to check their Medicare statements for fraud, errors, or abuse and never give out their Medicare number over the phone for any reason. Help your loved ones create a Medicare.gov account to access their Medicare claims online or remind them to open and review their statements when they come in the mail every three months. You can also register their phone number on “do not call” lists and go to optoutprescreen.com to opt out of mailings.
Partners and professionals, help by sharing SMP information on social media, referring clients and consumers to the SMP, and inviting the SMP to speak during a shared event. Identify ways to collaborate on mission-related topics and information.
Health care providers, help by talking to patients about health care-related scams such as those related to durable medical equipment and genetic testing schemes. Remind them that products and services should only be ordered by physicians they regularly see. Needed medical items should never be ordered through TV ads or unsolicited calls.
Lastly, as a community, help by looking out for your older neighbors. When in public, be aware of older individuals purchasing gift cards in large amounts. If you overhear someone talking about Medicare, don’t be afraid to offer information about SMP and SHIP. Encourage those you know to talk to a trusted source about their Medicare questions and tell your neighbors about the most recent Medicare scams. Consider volunteering with your local SMP!
