Medicare fraud is one of the most pervasive forms of fraud in the US. It is estimated that the federal government loses $75 – $250 billion annually as a result of Medicare fraud. However, the government isn’t the only victim.
Thousands of Medicare recipients find themselves at the center of fraudulent schemes. Although few of them face financial liability, many wind up with compromised medical and insurance records which set them up for problems down the road.
A case in point is a man, mentioned in a 2010 New York Times article, who needed a wheelchair. When he applied for it using Medicare, he was denied, because according to his records, he had received a wheelchair five years before. The only problem is that the man hadn’t received any wheelchair. A fraudster had used his details to bill Medicare for a wheelchair. Click here to read more.
Such scenarios aren’t uncommon. This is why you need to protect yourself against Medicare fraud. A fraudulent act committed in your name may not affect you immediately. However, it can become a serious problem at the point of your greatest need. In order to protect yourself, you first need to have a basic understanding of how Medicare fraud works.
How Medicare Fraud Works
At a basic level, Medicare fraud is illegitimately billing Medicare. This usually takes two forms. The first is billing Medicare for services which are not provided, or billing Medicare at excessive rates. The second is supplying Medicare recipients with unnecessary or substandard medical products/services, and then billing Medicare for it.
For both forms of Medicare fraud to work, the fraudsters need access to genuine Medicare credentials. As such, most of the fraudsters’ activities are aimed at stealing people’s Medicare credentials. They use a number of tricks from posing as government Medicare reps to pretending to be healthcare practitioners, or even conniving with genuine practitioners in order to access people’s Medicare credentials.
How To Protect Yourself
Given that the primary aim of Medicare fraudsters is to steal your credentials, protecting yourself is mostly about preventing the theft of your Medicare card or number. Some of the tips you can use are the following:
Guard Your Card
You should protect your Medicare card with as much care as you would your credit card or social security number. Do not give it out to anyone – especially on phone. Many fraudsters trick people into releasing their Medicare numbers by calling them up and pretending to be government representatives.
A great way to protect your card is to make a colored copy of it, and then black out all the digits except the last four. You can then laminate it, and use it during doctor’s visits. The original can be safely kept at home. This can prevent your card from being stolen. Remember, most health service providers require your original card only during your first visit. On subsequent visits, you can move along with your colored copy.
Beware of the Free Services Scam
A common trick used by fraudsters to collect Medicare numbers is through offering “free” services. The only condition they give for getting their “free” services is you giving your insurance information. Do not fall for this scam. If a service is truly free, then what’s the point of asking for your insurance information?
The bottom line is this: don’t give your Medicare number to anybody claiming that they want to offer you a medical service for free. Such people are often fraudsters who are trying to trick you into revealing your Medicare number.
Speaking of freebies, beware of medical supplies which you receive without having ordered for them. Some fraudsters steal your Medicare credentials, send you substandard supplies (often that you don’t need) and bill Medicare on your behalf.
If you receive medical supplies which you didn’t order for, it is almost always a sign that your Medicare credentials have been stolen. First of all, check with your healthcare service provider to ensure that they didn’t send it by mistake. Next, check your Medicare statements (more on this shortly). If you account has been billed without your permission, then report the matter to the Inspector General.
Examine Your Medicare Statements
The quickest way to identify Medicare fraud is through your statements. An easy pointer towards fraud is when you find records of doctor’s visits you didn’t make, unfamiliar medical provider names, or medical supplies you didn’t receive in your Medicare statement.
When you find unexplainable records in your Medicare statement, the first thing is to contact your health service provider – sometimes it can be a simple mistake. If the provider is a baffled as you are, then you are probably a victim of fraud, you need to report it immediately.
The best strategy for examining your Medicare statements is to keep a record of your medical the medical services and supplies. These can include doctor’s visits, equipment ordered for, labs, tests and procedures. Also, keep records of pathology reports and test results. When examining your Medicare statements, check them against your records. This makes identifying fraudulent charges much easier.
Get A Second Opinion
Medicare fraud isn’t just a matter of using your credentials without your information. Some practitioners can actually treat you for nonexistent conditions. A case in point is Dr. Farid Fata – the Michigan-based physician who was recently sentenced to 45 years in prison. Dr. Fata admitted deliberately misdiagnosing patients (telling them they had cancer), and then giving them cancer treatments – even those who were healthy. (http://edition.cnn.com/2015/07/10/us/michigan-cancer-doctor-sentenced/)
Although this is an extreme example, cases like this aren’t uncommon. Healthcare providers sometimes subject patients to unnecessary procedures, tests and treatments – for the simple reason of wanting to claim Medicare reimbursements.
To avoid becoming a victim of such fraud, please ask for a second opinion – especially for serious diagnoses like cancer. Medicare covers getting a second opinion and even a third – in case the previous two are divergent.
The bottom line is that you shouldn’t take every diagnosis as the gospel truth. If you are suspicious about any diagnosis, then request for a second opinion. A genuine medical service provider will have no problem having their diagnosis confirmed by another expert. If the service provider becomes defensive, then that can be a pointer towards the fact that the diagnosis is false.
In a nutshell, those are a few tips which you can use to protect yourself against Medicare fraud. In case you need help in identifying a fraud, then contact your state’s Senior Medicare Patrol Program, or call 877-808-2468. If you suspect that you are a victim of Medicare fraud, call the Inspector General’s fraud hotline at 800-447-8477.