Medicare Fraud Prevention

A: When someone intentionally uses your Medicare number to obtain services for themselves or when a provider intentionally submits claims to your insurance to get paid for services you didn’t receive, it is fraud.

Here are four signs that your Medicare number may have been stolen:

1. You get a call from a healthcare provider or a debt collector about services you didn’t receive. Ask for specifics about the services, like dates and names of the people who did the work. If you didn’t receive the services, report it as potential fraud.
2. Use a calendar or planner to write down your medical appointments, tests, and prescription refills, and use this information to compare your bills.
3. If you have a Medicare Advantage plan, you will receive an Explanation of Benefits each time they process a claim. Always review your Explanation of Benefit documents to confirm it is a service you received and understand your cost sharing.
4. If you have Original Medicare Parts A and B, you will receive a Medicare Summary Notice every 3 months that shows a summary of the services paid by Medicare during the three month period. Always review this statement to confirm you received the services.

A: You have options:

• Call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.
• Call the fraud hotline of the Department of Health and Human Services Office of the Inspector General at 1-800-HHS-TIPS (1-800-447-8477). TTY users can call 1-800-377-4950.
• Contact your local state Department of Insurance.
• If you have a Medicare Advantage plan, contact your plan.

A: You might have to fill out a “request” form and pay a fee based on the cost of making copies. Your provider or plan should tell you about any fees when you request. If they don’t, you should ask. The cost can only be for the time it takes to make the copies, the supplies needed to make copies, and postage (if required). Most of the time, you won’t have to pay to look up information, search for it, download it, or send it through an electronic portal.

A: Congress created the Medicare Beneficiary Ombudsman (MBO) to help Medicare beneficiaries with questions, complaints, grievances, appeals, and information requests. The MBO supports CMS’ customer service and administration activities by receiving and responding to beneficiary and stakeholder inquiries and complaints, working with partners to educate beneficiaries, and making recommendations to improve Medicare administration.

A: When someone uses your personal information without your permission, it’s called identity theft. Name, SSN, Medicare number, and credit card numbers are examples of personal information. Review your Medicare claims for errors and other fraud, and report anything suspicious to Medicare. Other preventative measures you can take are:

• Protect your Medicare Beneficiary Identification number and/or Social Security number.
• Keep your Medicare card safe.
• Know that Medicare will never call you unless you have been asked for a call back from a representative with 1-800-MEDICARE.
• Do not give any information to someone who claims to be calling from Social Security. Social Security will send you a letter if they need any information from you.