The process of deliberately billing Medicare for services that were neither received nor provided is called a Medicare fraud. Millions of Americans are being affected by Medicare fraud. Recently, fraudulent schemes have developed more elaborate and bolder procedures, thus resulting in hundreds of millions of dollars in false billings to Medicare. Such actions can cause misuse of taxpayer dollars and misdirection of funds, which are intended to aid the beneficiaries.
Although the U.S. Department of Health and Human Services is doing appropriate measures to eliminate the Medicare fraud, you must also be aware of such fraudulences in order to protect yourself from them.
How to Determine a Medicare Fraud
Determining what may cause a possible fraud can help you protect yourself from it. There are several ways to detect a Medicare fraud and you should always be suspicious of providers that tell you something that is beyond your knowledge. For instance, if the provider tells you that a certain test is free but he or she only requires your Medicare number for his records, you must know that the provider is trying to pull a scam on you. Always remember that for clinical laboratory tests, co-payment is not required and the provider can state that the test is free, in good faith, since there is no charge for the tests to a person with Medicare.
In addition, be suspicious if the provider tells you that Medicare requires you to have the item or service. Other fraud indication may include the provider telling you that they know how to obtain Medicare to pay for the service or the more tests they give you the cheaper will it cost you. Lastly, be suspicious of a provider that tells you the service or equipment is free and it would not cost you anything.
How to Report a Fraud
As a Medicare beneficiary, you must be aware of the healthcare services that you have acquired. When you receive your Medicare Summary Notice, it is important to make sure that you understand all the items listed.
If in case you do not remember a procedure listed, you must first call your physician, supplier or provider that is also listed in your report. These people can help correct simple mistakes and can help you obtain information regarding your report that you might have forgotten.
However, if the mentioned people cannot help you with the questions or concerns you have, you should call or write the Medicare company that paid the claim. The name, telephone number and address of the company is also listed on your Medicare Summary Notice, which also shows what Medicare services are already paid.
How to Avoid the Fraud
In order to help prevent a Medicare fraud, you should report any suspected instances. If you have received a payment notice from Medicare, it is important to review that notice. The notice can include the billed Medicare, paid Medicare and how much you owe. Always ensure that Medicare was not billed for any health care services or supplies that you did not receive.
To help you avoid a fraud, remember not to give out your Medicare Health Insurance Claim Number indicated on your Medicare card to anyone except to your physician or other Medicare provider.
In addition, avoid providers or health care services or products who tell you that the item or service is not normally covered but they are knowledgeable on how to bill Medicare to get it paid.
How to Protect Yourself from the Scam
There are several ways that can protect yourself from Medicare frauds that are rampant everywhere. Always be vigilant and suspicious of providers that will charge you co-payments on clinical laboratory tests and other Medicare covered preventive services, such as: prostate specific antigen or PSA tests, PAP smears and pneumonia or influenza shots.
Also, avoid providers that actively waive co-payments on any services without even checking your ability to pay. More so, if a provider claims that they represent Medicare, make sure that you know his or her name and check with your provider. Lastly, be suspicious of providers that use door-to-door and telemarketing techniques as marketing tools and others who pressure or scare you in buying high-priced medical diagnostic tests or services.