How to Avoid Medicare Fraud

Your Medicare number is the key to your health coverage. If stolen, you could be dealing with fraudulent charges or medical identity theft. Even if you avoid a scam, ongoing Medicare fraud is costly. It could mean higher deductibles, bigger co-payments and cuts to services and care.

There are simple steps you can take to recognize and report Medicare fraud. By catching fraudulent activity early, you can protect yourself and help all Medicare payees. 

Know what to expect from Medicare

To recognize suspicious activity, it’s important to know when Medicare communicates with its members. According to the Centers for Medicare & Medicaid Services (CMS), Medicare plans may only contact enrollees to discuss plan types or benefits. Be wary of unusual contact or any requests for your Medicare number.

Medicare will never:

• Ask for your Medicare number or personal information unless we obtain your permission in advance
• Call to sell you anything
• Visit you at home without a scheduled appointment
• Enroll you over the phone unless you initiated the call
  

Protect yourself from a Medicare scam

Your Medicare number is like your Social Security or credit card numbers. You are at risk for a Medicare scam or identity theft if it gets into the wrong hands. But unlike credit cards, your Medicare card offers no consumer protection. Be cautious of sharing your Medicare card or number with anyone. Exceptions include your doctor, or other Medicare providers and family members you trust.

Call Medicare if you think you’re the victim of a Medicare scam.

Remember that your Medicare number also appears on your medical statements. Do not share these documents with anyone. When disposing of old statements, shred the paperwork.

Log your use of Medicare coverage

Keep a thorough record of all medical visits, receipts, and prescriptions. Mark your doctors’ appointments on a calendar to review service dates with your insurance statements. After a physician visit, examine the receipt immediately for mistakes. If you don’t understand a charge, ask your provider’s office to explain.

Check your Medicare claims and statements

No matter which Medicare plan you have, you’ll receive regular statements outlining the services used. If you have Original Medicare, a Medicare Summary Notice (MSN) comes every three months by mail. Or every month by email (if you choose to receive MSNs electronically). For Medicare Advantage plans, the statement frequency varies by plan.

Compare your MSN or statement and any processed claims to your calendar and receipts. Verify the dates of service, the providers seen and the amount charged. If you suspect Medicare fraud, promptly contact Medicare or your insurance company.

Report Medicare fraud

Report right away if you suspect fraudulent activity with your Medicare coverage. If you have Original Medicare, you can call 1-800-MEDICARE (800-633-4227). (TTY call 1-877-486-2048). 24 hours a day/7 day a week. For fraud related to a Medicare Advantage or Supplemental plan, call the Medicare Drug Integrity Contractor at 877-772-3379. Before making the call, be sure to have:

• Your Medicare number
• The provider’s name and information
• The date of the service in question
• The amount approved and paid by Medicare
• The date on your MSN or claim