Have you ever wondered…
I heard about a Medicare fraud case on the news. I’m worried it will happen to me. How can I protect myself from Medicare fraud?
Response:
There are steps you can take to be vigilant, since Medicare fraud and scams are common and increasingly sophisticated. Medicare fraud can take different forms and happen at various times. For example, Medicare fraud can happen:
Before you enroll in a Medicare Advantage or Part D plan
When you go to a doctor’s office or a facility
When people see your electronic or physical medical records without your permission
Below are some common Medicare fraud patterns. Knowing them can help you recognize higher-risk situations and take action to protect yourself.
Billing fraud occurs when Medicare, and you, are charged for services you didn’t need or receive. This could come from a provider you didn’t see at all, or a provider may include inaccurate claims along with legitimate ones.
Keep in mind:
Suppliers should not send you equipment, supplies, or orthotics that you did not request.
Your doctor should not charge you cost-sharing for most preventive services.
Your doctor should not offer unnecessary tests or services, especially if incentives are involved.
If you return durable medical equipment (DME), your supplier should not continue to bill Medicare for rental or maintenance.
Always check that the services listed on your Medicare Summary Notice (MSN) or Explanation of Benefits (EOB) were actually received.
Misleading marketing can involve:
Misrepresenting the benefits you’re entitled to through Medicare or Medicaid
Pressuring or threatening you with negative outcomes if you don’t enroll in a specific plan
Trying to improperly influence your enrollment in a Medicare Advantage or Part D plan
Here’s how to protect yourself:
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