How to Avoid Medicare Fraud and Report It

Few people are aware that the Medicare program costs the industry billions of dollars annually, increasing the cost of service for everyone and thereby damaging it fundamentally. Fraudulent calls are becoming more and more common with individuals trying to access Medicare numbers and bill the government-run program for senior people (65 years old and above) and/or disabled. Working with and learning from the experiences of individuals like Jessica Vigil, fraud can easily be avoided.

medicare fraudUnderstanding Medicare Fraud

Unlike Medicare abuse, wherein the healthcare provider is not following healthy medical practices such as performing services unnecessarily, but as serious, illegal, and punishable an offence, Medicare fraud is for someone who consciously bills the Medicare system for services that the supposed beneficiary never received. They are using it for their own benefit. Period.

It’s possible sometimes for the provider to make a mistake and use a different medical code when submitting the claim to Medicare. They may not be planning to deceive the system, but it does determine how much you pay for the service. That is why you should be paying close attention when the insurance company or Medicare sends over the payment notice so you can talk to the right authorities and find or understand why it’s correct or erroneous.

How to Detect It

  • Protect your Medicare, bank account, and Social Security numbers. Never accept free services from people offering it in exchange for your Medicare number, especially if they tell you too that they know how to get Medicare pay for a service not covered by your plan.

Also, Medicare is never going to call you so anyone claiming it on the line is bound to be lying; you can further establish it by asking for their name and number instead.

  • With Jessica Vigil, fraud like this wasn’t excused on the basis that she knew nothing about it. Hence the reason to educate you about it, emphasizing that you should know exactly what you are entitled to, and what the provider can or can’t bill to the program.

It’s best to use a calendar and record your appointments as well as any tests just in case you forget the details, including not just the service but also the diagnosis and dates, when looking over the Medicare statements.

  • It’s always better to check with the doctor first if you spot suspicious activity. But if the problem isn’t an honest mistake, you have couple of reasons to report it, including major unpaid medical bills because Medicare denied payment due to the sheer number of claims even if some of them were completely legitimate.

Schemes like medical “discount plan” or fake online pharmacies target not the insurance company or government, but the consumer directly. Avoid them at all costs; also be alert and make sure to check your pills before leaving pharmacy to see if it’s the right medication and in full amount.

How to Report It

You can either call the health care provider listed on the Explanation of Benefits or Summary Notice to inquire about the service; call the senior Medicare patrol or the office of inspector general (US Department of Health and Human Services) if the issue remains unresolved.