Whether you’re a Medicare beneficiary or know someone who is, you’ve likely heard about the risks of Medicare fraud and medical identity theft. While the government is taking steps to mitigate these issues, there are things you can do now to protect yourself.
Medicare is one of the country’s largest programs, with more than 49 million elderly and disabled beneficiaries and an estimated cost of $555 billion in 2012, according to a Government Accountability Office (GAO) report.
Because of its size and complexities within the system, Medicare has been on the GAO’s “high risk” list since 1990. The GAO report cited an estimate of more than $44 billion in improper payments in the Medicare program in 2012 alone.
The GAO report also notes that reducing Medicare fraud is a priority of the current administration, and while improvements have been made, improper payments are still a major issue for the program.
As the government works to avoid Medicare fraud on its end, the administration also looks to Medicare patients to help avoid fraud by recognizing and reporting instances of improper or false billing, according to the government’s anti-fraud website, www.stopmedicarefraud.gov.
People who report specific instances of Medicare fraud could receive rewards of up to $1,000 from the government.
Keep an eye on your medical records and notices
Preventing identity theft is an initial step to avoiding Medicare fraud. Consider keeping records of doctor visits, tests, and procedures, and carefully review Medicare Summary Notices and Part D Explanation of Benefits (EOB) statements. If you know your medical records well, you may be able to more easily detect errors or potential fraud. Medicare participants can always access their records at www.mymedicare.gov.
Notices and benefits information can be compared to personal records kept from doctor visits and prescription drug receipts to ensure they match. According to the government website, patients should examine billing statements for charges for services or medications they didn’t receive, billing for the same thing twice, or services that were not ordered by the doctor.
To avoid Medicare fraud and identity theft, you shouldn’t give your Medicare or Social Security numbers to anyone except licensed medical professionals. You can ensure you’re dealing with an approved Medicare provider by calling 1-800-MEDICARE. You can also call that number to report Medicare fraud or identity theft related to Medicare benefits.
Reporting fraud or identity theft to Medicare
To make a report, you’ll need to know:
- The service provider’s name
- The service or item in question
- The date the service or item was supposedly given or delivered
- The payment amount approved and paid by Medicare
- The date on your Medicare Summary Notice (MSN)
- Your Medicare number
- Why you believe Medicare shouldn’t have paid
- Any other information showing why Medicare shouldn’t have paid for an item or service
You should always be able to contact a health care provider to ask questions about your bills or to inquire about services you believe were unnecessary. Billing errors sometimes occur and often won’t be caught unless questioned by the patient.
Be wary of providers who say an item or service isn’t covered but that they “know how to bill Medicare” so the item will be covered anyway. By keeping an eye on your records, you can better help prevent your Medicare information from being misused or falling into the wrong hands.
Joslin Woods is a researcher, writer, and web producer, with a background in print and digital media. Previously, Joslin worked as a news reporter for the international news agency Agence France-Presse and as a freelance reporter for the Sun-Times News Group.
