Medicare fraud and Medicare scams are both deceptive practices that involve abuse of the Medicare system and its beneficiaries. 

Scams are designed to trick people into knowingly divulging sensitive information, which scammers can exploit at that person’s expense. Never divulge your Medicare information in response to a phone call, text, or email. Take the time to confirm the legitimacy of the contacting entity, confirm the contact information independently, and contact them in return. 

Fraud is a broader term that refers to the general misuse of personal information, inappropriate billing and payment practices, or other dishonest activity.  

If you have Medicare as your insurance provider, be sure to read the statements showing services provided to you. Compare them against a record that you should keep of your doctor, specialist, and therapy visits (something as simple as marking a calendar might suffice). 

Always confirm that you received the services listed on either your Medicare Summary Notice (MSN) or your Explanation of Benefits (EOB). Sometimes this can be hard to do if you received services from several doctors at the same time.  

If you have returned or canceled orders or durable medical equipment (DME), your supplier should not continue to charge Medicare for rental fees or maintenance. 

If there seems to be a mistake from one of your regular medical providers, call their office to straighten out the discrepancy.  

However, you may see an unfamiliar provider listed as having billed Medicare on your behalf for equipment or services that you never ordered or never received. In that case, you should contact both Medicare and any secondary insurance immediately to notify them of the fraud. Do not interact with the fraudulent provider or assume that it is a mistake that Medicare will catch. This is a form of identity theft since your personal information has been used fraudulently.  

Several Poolesville Medicare recipients have noticed fraudulent charges from Sunshine Senior Solutions in Florida. Please scrutinize any charges from this company and report any fraud. 

To report fraud, you should contact:  

  • Medicare directly at 1-800-MEDICARE (633-4227). 
  • The Senior Medicare Patrol (SMP) Resource Center (877-808-2468). 
  • The Inspector General’s fraud hotline at 1-800-HHS-TIPS (447-8477)  
  • If you have a Medicare Advantage Plan, contact your plan directly. Your plan’s phone number should be on the back of your benefit card and on your Explanation of Benefits (EOB). 
  • The Better Business Bureau for the state in which the company operates. 

 

Forbes Magazine reports that $68.7 Billion of the Total Health Care Fraud Losses are From Medicare and Medicaid Fraud. All Medicare recipients have an interest in reporting and preventing fraud. Medicare will not use your name while investigating any fraud that you report if you do not want it to. 

If you find out that your insurance plan has made fraudulent claims about your health or drug coverage, you may be eligible for a Special Enrollment Period (SEP) to disenroll from your plan and switch to another one.