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Examples of Medicare Fraud, Abuse or Scams
COVID-19 Related Scams
Intentionally billing Medicare for a service that was not received
- Billing for a service at a higher rate than is approved
- Billing for a service that is not medically necessary, such as excessive x-rays and lab tests
- Billing for supplies or equipment that were not medically necessary
- Billing for supplies or equipment that were not provided
- Using another person’s Medicare number to receive services
- Intentionally contacting beneficiaries for their Medicare number for fraudulent purposes listed above
Other Related Fraud
- Fake vaccines, cures, treatments or testing kits
- Schemes to sell N95 masks, gloves and other supplies that are not delivered or are of a lower quality than stated
- Contact tracing calls that are not from the Hawaii State Department of Health
- Visit hawaiicovid19.com for more information about COVID-19
- Insurance - Plan representatives, brokers or agents misrepresenting insurance products
- Charity - Schemes requesting monetary donations for charities that do not exist
- Investment - Ploys to obtain money for fraudulent investments
- Financial - Exploitation of older adults to access their assets and resources
Protect Yourself Against Identify Theft
You can protect yourself from identity theft and prevent health care fraud if you:
- Guard Your Cards – Do not share your Medicare or Social Security number with anyone unless you have given them permission in advance. Medicare will NEVER contact you to ask for your Medicare number, personal information, or to send you a new card. Medicare already has your information.
- Report lost or stolen Medicare or Social Security Cards to SMP Hawaii at 808-586-7281 or the Social Security Administration at SSA.gov.
- Shred all documents with personal information before throwing them away.
- Do not ever let anyone borrow or pay to use your Medicare number.
- Be suspicious of anyone offering you “free” products, medical equipment, or services.
- Pay attention to your intuition or gut feeling.
Detect Medicare Fraud
Prevention alone cannot protect you. Learn how to detect potential issues with these steps:
- Keep all health care documents and receipts – Compare this information to your medical statements. Ask SMP Hawaii for a free Personal Health Care Journal, click here.
- Always Review Medical Bills – Check your Medicare Summary Notices (MSN) or Explanations of Benefits (EOB) to be sure you and Medicare are only being charged for actual items and services received.
- Spot and Investigate Discrepancies – If Medicare claims your benefit was already used or it is denied due to lack of medical neccesity, perhaps an incorrect billing code or Medicare number was submitted.
- Report to SMP Hawaii – If you spot a discrepancy on your MSN or have questions about your medical statements, call SMP Hawaii for assistance or click here.