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Thursday, August 11, 2022

5 ways to protect yourself from Medicare fraud

Medicare fraud is big business, and like most businesses, it has adapted to the new environment of the COVID-19 pandemic.

“The public health emergency created an opportunity for fraudsters to modify and repurpose existing plans,” a spokesperson for the Centers for Medicare and Medicaid Services, or CMS, said in an email. CMS sees bad actors as avenues for identity theft and fraudulent billing, taking advantage of the widespread demand for telehealth, COVID-19 testing and vaccines.

The Office of the Inspector General of the Department of Health and Human Services, or HHS-OIG, investigates fraud, waste, and abuse in federal health care programs, including Medicare. According to HHS-OIG’s Spring 2022 Report to Congress, from April to September 2021, an average of about 9,000 calls came to its fraud hotline each month.,

Calling a fraud hotline is one of many actions a Medicare beneficiary can take to protect himself. Here are five tips to help you avoid, detect, and report Medicare fraud.

1. Protect Your Medicare Number

In the wrong hands, your Medicare number can be used to steal your identity or collect fraudulent medical bills.

“Our Top Tip is to Protect Your Medicare Same number as your social security (number) and credit card,” said a CMS spokesperson. “You should only share your Medicare number with trusted health care providers or verified COVID-19 vaccine administrators.”

Unexpected callers or visitors asking for your Medicare information are suspicious, especially if they claim to work for Medicare. According to the CMS, Medicare will never visit your home, and a Medicare representative will ask for your Medicare number by phone only if you have already given permission.

2. Beware of Free Gifts

Fraudsters may try to get your information by offering you something for free in return. If you are asked to provide your medical or financial information and have been promised a supposedly free gift or service, “that is something to question, or at least run by a medical professional.” The one you trust,” says HHS-OIG criminal investigator Isaac Bledsoe. ,

Common examples of free offers might include COVID-19 testing, genetic testing services or durable medical equipment such as walkers or braces.

3. Don’t Talk Unnecessary Care

Some plans include billing for expensive services you may not need. For example, unscrupulous COVID-19 testing sites may include unnecessary respiratory pathogen panels that can cost more than $500. This is according to a January 2022 white paper by the Healthcare Fraud Prevention Partnership, a public-private anti-fraud group.

If you are not sure, contact a trusted health care provider to confirm whether the service is necessary and what it may cost.

4. Review Your Health Care Documents

Medicare sends details to explain what you were billed for, how many services Medicare has approved and paid for, and the maximum amount your health care providers can pay. Watch out for any unexpected items or charges on these statements.

To help you keep track of everything, you can request a free “My Health Care Tracker” from your state’s Senior Medicare Patrol, or SMP. SMPs are grant-funded projects that provide resources and counseling to help combat Medicare fraud, errors, and abuse.

The My Health Care Tracker documents include sheets for recording information about your health care, instructions on how to compare your statements with billed statements, and contact information for agencies to help with issues such as errors or fraud.

5. Contact for help

If you’re concerned about potential Medicare fraud, there are free resources you can call on for help. Don’t hesitate to call even if you’re not sure. Bledsoe encourages beneficiaries to report “anything that you believe is potentially harmful or potentially fraudulent.”

There are two main government hotlines:

– Call CMS’s Medicare Help Line at 800-MEDICARE (800-633-4227).

– Call HHS-OIG’s Fraud, Waste and Abuse Hotline at 800-HHS-TIPS (800-447-8477) or file a complaint online at oig.hhs.gov/fraud/report-fraud.

You can also contact your Senior Medicare Patrol for help, and they can refer your issue to the appropriate authorities. Visit smpresource.org for contact information.

The one you call first can help, and you don’t need to contact a separate hotline. Bledsoe says that different agencies make coordination a priority, so “there’s no need to call nine different places to report it in nine different ways.”

“We can look into[issues]immediately and give a quick answer to ‘yes, this is something that’s not good,'” Bledsoe says. “We may put your Medicare number on a ‘potentially vulnerable’ list to look for any future billing you may not have asked for, and we can help you move forward.”


This article was provided to The Associated Press by personal finance website NerdWallet. Alex Rosenberg is a writer at NerdWallet. Email: arosenberg@nerdwallet.com.

Related Links:

NerdWallet: What is Medicare, and what does it cover? https://bit.ly/nerdwallet-what-is-medicare-and-what-does-it-cover

HHS-OIG Half-Yearly Report to Congress https://oig.hhs.gov/reports-and-publications/archives/semiannual/2022/2022-spring-sar.pdf

Senior Medicare Patrol https://www.smpresource.org/

World Nation News Desk
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