The most important step to avoiding Medicare fraud is protecting your Medicare number. Never give it out to someone who calls on the phone, someone who comes to your door, or to a Web site. The government never reaches out to Medicare recipients in these ways. In fact, Medicare is a bit like a guy or gal who's just not that into you -- Medicare never calls, never drops by. If Medicare is stalking you, something is very, very wrong. You can give your Medicare number out over the phone only if you're the one who called Medicare.
Most doctors have our best interests at heart, but some, unfortunately, are crooked. Be wary of a doctor who tells you that a service or a piece of equipment is free. Nothing is ever free. Doctors who rely on intimidation or scare tactics to get you to agree to certain medical tests or procedures shouldn't be trusted, and neither should doctors who say something like, "This won't be covered, but I can figure out a way to get Medicare to pay."
Whenever you have a doctor's appointment, make a note of the date you saw the doctor and the services you received. Then, when you receive a summary notice from Medicare, go over it carefully. If you see billings for any appointments, medical supplies or services that you didn't receive, then call your provider. It's possible that it was a simple billing mistake, or that you forgot to write down all the tests that were ordered. But if a doctor's office can't provide a reasonable response to the discrepancy, then you'll want to make a report directly to Medicare by calling 1-800-MEDICARE (1-800-633-4227). If you prefer to write an email or a letter, please see http://www.stopmedicarefraud.gov for contact information.
Guarding your Medicare number and studying your statement are the two best ways to protect yourself from fraud. But if you'd like to do more, consider joining the SMP Program. Formerly known as Senior Medicare Patrol, the SMP Program is comprised of senior citizen volunteers who teach their peers how to decode their summary statements. When something is fishy, the SMP volunteers turn the matter over to investigators. These crime-solving seniors have saved the government at least $100 million since 1997 [source: Sedensky]. If you're interested, you can find out more at http://www.smpresource.org.
For more on Medicare and other forms of health insurance, see the links below.
- Allen, Greg. "Medicare Fraud Acute in South Florida." NPR. Oct. 11, 2007. (July 22, 2010)http://www.npr.org/templates/story/story.php?storyId=15178883
- Allen, Greg. "Miami Serves as Model in Medicare Fraud Crackdown." NPR. Feb. 23, 2010. (July 22, 2010)http://www.npr.org/templates/story/story.php?storyId=123568789
- Associated Press. "Dozens Arrested in Medicare Fraud Totaling $251 Million." New York Times. July 16, 2010. (July 22, 2010)http://www.nytimes.com/2010/07/17/us/17fraud.html
- Centers for Medicare and Medicaid Services. "Protecting Medicare and You from Fraud." Department of Health and Human Services. May 2009. (July 22, 2010)http://www.medicare.gov/publications/pubs/pdf/10111.pdf
- Cooper, Helene and Robert Pear. "Obama Gets Tough on Health Care Fraud." New York Times. March 10, 2010. (July 22, 2010)http://www.nytimes.com/2010/03/11/health/policy/11health.html
- "Health Blog Q&A: $251 Million Medicare Fraud Crackdown." Wall Street Journal. July 16, 2010. (July 22, 2010)http://blogs.wsj.com/health/2010/07/16/health-blog-qa-251-million-medicare-fraud-crackdown/tab/print/
- Kennedy, Kelli. "Mafia, Violent Criminals Turn to Medicare Fraud." ABC News/Associated Press. Oct. 6, 2009. (July 22, 20100http://abcnews.go.com/US/wireStory?id=8765092
- "News Release: Attorney General Holder and HHS Secretary Sebelius Announce New Interagency Health Care Fraud Prevention and Enforcement Action Team." Department of Health and Human Services and Department of Justice. May 20, 2009. (July 22, 2010)http://www.hhs.gov/news/press/2009pres/05/20090520a.html
- Pear, Robert. "U.S. Is Asking for Patients' Help In Fight Against Medicare Fraud." New York Times. Feb. 21, 1999. (July 22, 2010)http://www.nytimes.com/1999/02/21/us/us-is-asking-for-patients-help-in-fight-against-medicare-fraud.html
- Potter, Mark. "Blatant Medicare fraud costs taxpayers billions." NBC News. Dec. 11, 2007. (July 22, 2010)http://www.msnbc.msn.com/id/22184921
- "Reports of Fraud Relating to the Affordable Care Act." HealthReform.gov. (July 22, 2010)http://www.healthreform.gov/fraud.html
- Sedensky, Matt. "Senior-Citizen Volunteers Fight Medicare Fraud." ABC News. Dec. 29, 2009. (July 22, 2010)http://abcnews.go.com/Business/wirestory?id=9442119&page=1
- Silberner, Joanne. "Medical Fraud Carries a Staggering Price Tag." NPR. Aug. 18, 2009. (July 22, 2010)http://www.npr.org/templates/story/story.php?storyId=111967435
- StopMedicare.gov Web site. U.S. Department of Health & Human Services and U.S. Department of Justice. (July 22, 2010)http://www.stopmedicarefraud.gov/