Medicare Fraud & Abuse
Recent news stories and newspaper articles are filled with accounts of Medicare fraud and abuse. Often fading to the background, these cases of fraud and abuse are costing taxpayers and Medicare programs billions of dollars each year. You do not have to be an expert to detect, report, and protect against fraud and abuse. Everyone can do their part to save themselves and Medicare from becoming victims of fraud. Below are some basic questions about how to detect and report fraud and abuse.
What is Medicare fraud?
Medicare fraud is defined as knowingly and willfully executing, or attempting to execute, a scheme to defraud the Medicare program. Examples of Medicare fraud would be billing for services that were not provided, ordering unnecessary tests, offering bribes, billing seperately for services that should be included in a single service fee, or billing non-covered services as covered services.
What is Medicare abuse?
Medicare abuses are incidents or practices where Medicare is billed for services that are not covered or are not correctly coded. Innapropriate practices that start as abuse can evolve into fraud. Examples of Medicare abuse include claims for services that are not medically necessary, routinely submitting duplicate claims, collecting more than 20% coinsurance or the deductible on claims filed with Medicare, or other improper billing practices.
What is being done to stop this?
In 2011, Medicare fraud and abuse costs were $60 billion nationwide. Through Medicare, the federal government has a program called Senior Medicare Patrol (SMP). The Patrol is made up of senior volunteers who want to fight fraud and abuse by educating other seniors about how to read the signs and detect fraud and abuse. The SMP program began in 1997, and since then has saved Medicare $105.9 million, and volunteers have educated more than 9.2 million people about fraud and abuse. The local SMP program is RSVP of Lincoln County and can be reached by phone at 541-574-2684, by email firstname.lastname@example.org, or by visiting our website at www.rsvpoflincolncounty.org.
What should I be looking for?
Stealing a Medicare ID number is a new means of identity theft. There are many schemes and scams you should be aware of. Do not give your private information out if you suspect any of the following scams:
- Free Medical Tests/Services: Companies use phone solicitation, ads in newspapers, and coupons mailed or delivered to consumer’s homes to advertise free testing or services. They ask you to complete a form to receive these free tests or services. These forms often ask for Medicare, Medicaid, SSN, or insurance numbers.
- Telemarketing: Callers use a high-pressure sales pitch to obtain Medicare, Medicaid, SSN, or private insurance information. These callers deliberately confuse people into believing the caller represents the government or private insurance. Do not give your private information out over the phone.
- $299, $389, or $399 Scams: Telemarketers identify themselves as a prescription drug plan, and offer a plan that will provide a year’s supply of prescription drugs for one payment of $299, $389, or $399. The beneficiary is told payment can only be made by automatic withdrawal, and then is asked for his/her Medicare number and bank account number. The money is either withdrawn or the bank account is completely cleaned out. Do not give your private information out over the phone.
- Other Free Services: There are many free services and products that are offered to Medicare beneficiaries. Promoters for these products often visit living facilities and senior communities offering free products and services. Promoters tell beneficiaries that Medicare wants to take care of them by offering these free services or products. The beneficiary is often asked to fill out a survey that asks for their Medicare ID number or other private information. These promoters are not associated with Medicare; do not give your private information to them.
What should I do if I suspect fraud or abuse?
If you have questions about your Medicare Summary Notice or Part D Explanation of Benefits, call your provider or plan first. If you are not comfortable calling your provider or plan or you are not satisfied with the response you get, call your local SMP program, which is RSVP, at 541-574-2684 or email email@example.com.
How else can I help?
If you are interested in becoming an SMP volunteer, contact your local SMP program, RSVP, at 541-574-2684. Or email firstname.lastname@example.org.