How to Report Suspected Medicare Fraud
Have you or someone you know ever experienced fraud? Here are two steps that you can follow to help if this situation occurs.
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Medicare Plan Specialist
Fraud happens when Medicare is billed for services or supplies that you never got. Fraud costs Medicare, and ultimately US taxpayers, billions of dollars every year.
You can help stop fraud in two easy steps:
1. Review each Medicare Summary Notice (MSN) or Explanation of Benefits (EOB) as soon as you receive it.
2. Follow up on anything you see that you don’t understand.
Medicare sends you a summary notice every three months, if you have Original Medicare. You can also see these documents online at MyMedicare.gov. You’ll need to register on the site. If you have a Medicare Advantage plan or a prescription drug plan, your plan sends you a monthly statement (EOB). Many plans also have member web sites where you can register to view your EOBs online.
What to Look For
It’s important to review every MSN or EOB right away. The sooner you spot and report any potential error, the sooner Medicare can get to work to track it down.
Look first for any unfamiliar provider names. This could be a clue, so check those items carefully.
As you review your statements and charges, look for:
- Doctor visits you did not make
- Prescriptions you did not fill
- Procedures or tests you did not have
- Medical supplies or equipment you did not get
It can be difficult to remember appointment dates and purchases after the fact. You may want to keep notes on a calendar or in a medical diary, along with receipts. This information can be a big help when it comes time to review your MSN or EOB.
What to Do
It’s best to call the provider or supplier of the suspected charge first, if you can. Someone there may be able to explain the charge to you. Or you may help them discover an error in their billing. You may also call your plan sponsor. The number is usually on the back of your member card.
If you still have questions or suspect fraud, you can call the Medicare Hotline at 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048, 24 hours a day, seven days a week.
You can help make Medicare’s investigation easier by providing the following when you call:
- The provider’s or supplier’s name and any identifying number you may have
- The service or item you’re questioning
- The date the service or item was supposedly given or delivered
- The payment amount approved and paid by Medicare
- The date on the MSN or EOB in question
- Your name and Medicare number
- The reason you think Medicare shouldn’t have paid
- Any other information you have showing why Medicare shouldn’t have paid for a service or item
If you prefer to remain anonymous, you can report suspected fraud to the Office of the Inspector General (OIG). You can make your report online at OIG.SSA.gov/report or by calling the OIG Hotline at 800-447-8477 (TTY 800-377-4950), 24 hours a day, seven days a week. The OIG will not record any information that may trace the report to you. However, a complete investigation may be impossible without your contact information.
You can learn more about protecting yourself and spotting fraud by contacting the Senior Medicare Patrol (SMP) in your area. The SMP is a program that trains senior volunteers to teach Medicare beneficiaries how to protect themselves against fraud.
–This information was provided by Medicare Made Clear
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