Home » News & Events » Aging Well: Spotlight on Medicare Fraud
Protect. Detect. Report. — How to Fight Medicare Fraud with SHIP
Security experts constantly tell us we should routinely change all our passwords and never divulge any personal information like our social security number or banking information to people we don’t know or aren’t sure about, especially when they initiated the contact. This applies to requests online or by telephone. All this helps to avoid fraud and identity theft, but people may not realize that there is an entire world of scams directly tied to Medicare beneficiaries and the Medicare payment system.
The Jewish Council for the Aging’s State Health Insurance Assistance Program (SHIP) has advice for preventing and protecting yourself against Medicare identity theft and ensuring that Medicare recipients are not subject to fraud.
Medicare identity theft happens when a bad actor steals or uses someone else’s personal information to submit fraudulent claims. SHIP Director Rafael Espinoza advises Medicare recipients to protect their information and Medicare and Social Security cards. He tells people to be sure they are giving their information to the proper person – and if they are unsure, contact Medicare or their provider directly. One opportunity for scammers to strike is when recipients are signing up for a new Medicare plan or changing their current one, so it is important to be especially careful about making those changes, he said.
Medicare loses about $60 billion annually due to fraud, errors, and abuse, and that hurts everyone, even people not on Medicare. According to Espinoza, when scammers and corrupt medical providers abuse the system, it may not have an immediate or direct financial effect. But when Medicare loses that money, the result often is higher monthly rates for Medicare beneficiaries down the road, increases in copayment or deductibles, and greater hospital and doctor bills for everyone in an attempt to make up for the losses due to fraud. Medicare is funded first by payroll taxes and premiums, but some is paid by general federal revenues, so we all pay when there is fraud in the system.
Learn to spot the signs: Be suspicious of medical providers who don’t charge copayments without first checking your ability to pay, according to advice from Medicare. Be wary of advertisements that state the consultation is free if you have Medicare and use pressure or scare tactics to sell you additional services.
The best thing Medicare recipients can do is check their bills and review what charges were made. If there are costs for medical equipment and services that don’t make sense, or you know you did not receive or need, do not just brush them off because Medicare covered those items. Set up an online account with Medicare to keep careful track. The Medical Summary Notice is where the health care services, supplies, and equipment are listed on your Medicare account. The printed copies come in the mail only every three months. “Look at your Medicare account. Review it, make sure whatever is billed to Medicare is what you received,” Espinoza said. “If you suspect fraud, report it.”
Medicare often takes years to investigate fraud, but it is not at all uncommon for the guilty party to be arrested, convicted, and sentenced to prison time. In April, the U.S. Attorney’s Office for Maryland obtained a $1.4 million judgment against a family doctor practicing in Takoma Park. The doctor was cited for submitting false claims or causing false claims to be submitted to Medicare. “This type of fraud not only wastes taxpayer dollars, it also undermines trust in our healthcare system,” said U.S. Attorney Kelly O. Hayes.
Protect. Detect. Report.
These are the three words both Medicare and SHIP constantly advise recipients.
To report fraud, call 1 800-633-4227 or the fraud hotline of the Department of Health and Human Services Office of the Inspector General at 1 800-447-8477. You can also file a complaint online.
SHIP provides Montgomery County seniors and adults under 65 with long-term disabilities with health insurance counseling, enrollment guidance, and assistance and problem resolution for issues relating to Medicare benefits and other public and private health insurance sources. To contact the SHIP office, call 301-255-4250 or email. For more information about Medicare, check out the SHIP website.
