Preventing Medicare Fraud

Each year, Medicare loses billions of dollars due to fraudulent behavior from dishonest people. In 2020, the U.S. Government Accountability Office estimated that Medicare payments of either an incorrect amount, or that shouldn’t have been made at all, reached an estimated $43 billion. Why does this matter? Millions of people in the United States depend on Medicare for their healthcare needs. This fraud not only costs taxpayer dollars, it also hurts the program as a whole because it raises the cost of health care for beneficiaries of the program. So, what can we do to stop this? In this article we’ll cover:

When and how Medicare fraud occurs

Medicare fraud usually occurs when medical suppliers or healthcare providers bill for or inflate the cost of equipment, services, or medication that they didn’t actually provide. Unethical providers will go so far as falsifying diagnoses to justify unnecessary services, including surgeries, or use real patient information obtained through identity theft to create fake claims.

If you or a loved one are victims of Medicare fraud, the burden of proof may fall on you, especially in cases where a person has managed to steal your Medicare card and bill fake services in your name. This is why it’s important to be able to protect yourself from Medicare fraud. Fortunately, there are steps you can take to detect this type of fraud, protect yourself from it, and report it when you encounter it.

Detecting Medicare Fraud

Identifying Medicare fraud can be easy if you know which red flags to keep an eye on. Common schemes used to exploit Medicare recipients are:

  • Pressure to buy higher priced services
  • Charging copayments on services that are supposed to be fully covered by Medicare
  • Offering “free” services in exchange for your Medicare card number
  • Telemarketers, robocalls, or door-to-door salespeople using scare tactics or saying they represent the government to get your Medicare number
  • Getting people signed up for services that they never receive
  • Clinics write fake prescriptions or order unnecessary tests and bill Medicare

To detect Medicare fraud, keep records of visits to health providers that include the date of service, the name of the provider, the service or goods received, and the amount charged. Compare statements your provider sends with the records you keep, and make note of any discrepancies.

If you notice that something is off, first contact your provider to make sure it isn’t an honest mistake. However, if the issues persist, this might be a sign that something is wrong.

Preventing Medicare Fraud

Fortunately, there are things you can do to protect yourself from Medicare fraud. Take the following steps to avoid falling prey to Medicare fraud:

  • Protect your Medicare number, and treat it the same way you treat your Social Security number. Only share it with trusted providers.
  • If a provider pressures you to get services or tests that you feel are unnecessary, get a second opinion or turn down the service.
  • Keep records of medical appointments and services with all receipts and statements from providers.
  • Turn down “free” medical supplies, services, or equipment that ask for your Medicare number.
  • Don’t accept gifts or money for free medical care.
  • When someone other than medical professionals want to see your medical records or recommend services, proceed with caution.

Protecting your personal information and Medicare number is the best way to fight Medicare fraud and abuse, so be sure to actively keep this information safe.

Reporting Medicare Fraud

In the unfortunate case that someone becomes a victim of Medicare fraud, they can report fraudulent behavior to Medicare. Before contacting Medicare, have the following information on hand:

  • The provider’s information, which includes their name, phone number, address, and type of practice
  • The item or service that was billed incorrectly and the date the service or item was provided
  • The amount charged and approved to Medicare
  • The date on your Medicare Summary notice
  • Reasons why you think it is a false billing

Anyone can call 1-800-MEDICARE (1-800-633-4227) to report Medicare fraud 24 hours a day, seven days a week.

If you need help navigating the ins and outs of Medicare, one of our licensed Medicare representatives I happy to help. Just go to Guided Medicare Solutions for more information.


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