How To Prevent Medicare Fraud

Medicare fraud is a rampant problem that’s causing taxpayers unnecessary costs. The amount of money lost to Medicare fraud is estimated to be $60 billion per year, a full 10% of Medicare’s total costs. With a system as large and complicated as Medicare, catching the fraud when it happens is an uphill battle. Seniors can do their part by keeping eye out for potential abuses and drawing the line if they’re ever encouraged to participate in Medicare abuse.

There are two main types of Medicare fraud:

• Medical professionals charging Medicare for services you didn’t receive, or providing services you don’t need in order to be able to charge them to Medicare.

• A version of identity theft in which someone uses your Medicare card or number in order to get services for themselves.

Obviously, both types are best avoided.

6 Tips to Avoid Medicare Fraud

1. Keep your Medicare and social security numbers secure.

Don’t share them with anyone that doesn’t need them for medical purposes (like the staff at your doctor’s office) or that you don’t trust completely. Some fraudsters manage to cheat Medicare successfully simply because a senior was polite enough to provide them with sensitive personal information when asked. Guard that information carefully and never reveal it to a stranger. 

2. Don’t carry your Medicare card with you at times you don’t need it.

It’s easy enough to stick your Medicare card in your wallet or purse and not think about it, but if your wallet gets stolen or you forget it somewhere in public, thieves will have access to the information they need to claim your Medicare benefits as their own. This means you’ll have to make a special point to remember it the times you do need it, but that’s much easier than having to deal with identity theft.

3. Speak up during your doctors’ visits.

It’s natural to want to trust our health care providers implicitly and assume everything they suggest is for the best. But the way our health care system is structured now means that medical professionals can often benefit by running tests or performing medical procedures that aren’t actually necessary. Don’t be afraid to ask questions about the treatments your physicians recommend. Ask if they’re really necessary, what would happen if you didn’t pursue that treatment option, and how the costs of the different options compare.

4. Review your Medicare statements.

Part of what makes Medicare fraud easy to get away with is how many people don’t ever bother looking at their statements. You should document your healthcare as you go – what appointments you have, what procedures and tests occur, and what prescriptions you’re given. Then, when your statement comes in, check your records against what’s there.

You’ll see if anything was charged twice or tests show up on the bill that were never mentioned during your visit. Talk to your doctor about anything on the statement that doesn’t look right to see if they have a sensible explanation. If not, you may be dealing with fraud.  

5. Don’t believe it if someone who comes to your door or calls you on the phone claims to be from Medicare.

Medicare will never contact you door-to-door or solicit personal information over the phone. If someone does contact you in one of these manners and try to sell you medical products and services or ask for your Medicare number, tell them no and report them.

6. Don’t buy in to prescription ads.

Medicare abuse extends to patients requesting and receiving services they don’t need. Pharmaceutical ads are often designed to make you think you have health problems you don’t and need their treatment for it. Be skeptical.

How to Report Medical Fraud

If you suspect Medicare fraud is occurring, you can report it by calling 1-800-HHS-TIPS or emailing HHSTips@oig.hhs.gov. Describe all the details you know about the incident and let them know any information you have about the offender.

Kristen Hicks

Kristen Hicks is an Austin-based copywriter and lifelong student with an ongoing curiousity to learn and explore new things. She turns that interest to researching and exploring subjects helpful to seniors and their families for SeniorAdvisor.com.