Medicare Fraud is on the Rise

Be on the look-out! Medicare seems to be sending an increasing number of written statements indicating services from doctors the patients never heard of, and certainly never met. Although such billings can usually be explained as valid and correct, there is no question that Medicare fraud is on the rise.

A Medicare Summary Notice or MSN is the statement received by Medicare beneficiaries that lists recent services provided, the charges Medicare approved and paid, and the remaining balance that the Medicare beneficiary will likely receive. The same statement is provided to Medigap or retiree plan beneficiaries who receive an Explanation of Benefits or EOB.

Since routine care often includes lab tests, x-rays and other healthcare services, a greater number of beneficiaries are finding names of unknown providers on their MSNs or EOBs. Unfortunately, although most charges turn out to be appropriate or may simply be mistakes, incidences of Medicare fraud have drastically increased.

Medicare fraud occurs when healthcare providers or suppliers of durable medical equipment, billing services or others seek Medicare reimbursements for treatments, equipment or supplies that were never provided to the beneficiaries as claimed. As examples, Medicare has been receiving more and more bills including:

• Specific services, equipment and supplies that the beneficiary neither requested nor received.

• Unnecessary and uncovered tests that were claimed to have been provided at health clubs, retirement homes, or shopping malls, and

• False diagnoses submitted to obtain reimbursement for the actual services provided that Medicare does not cover.

According to the FBI, seniors have become primary targets of medical equipment schemes. In a standard scenario, seniors are asked to provide their Medicare health insurance claim numbers in order to become eligible to receive free products or gifts. Once the beneficiaries’ numbers are obtained, the scammers are able to provide Medicare with present, and also continuing, fraudulent claims.

The FBI and Center for Medicare & Medicaid Services have set forth recommended ways for seniors to protect themselves from becoming victims of Medicare fraud:

• Never sign blank insurance forms.

• Keep a record of your doctor visits and the processing of your bills.

• Make sure your physicians provide you with prior notice before ordering equipment, including specific details on what your out-of-pocket costs will be.

• Timely review your MSN or EOB for errors by comparing it to the medical services and supplies you actually received.

• As a condition for receiving free medical equipment or care, do not provide anyone with your Medicare number since, according to state and federal laws, the provision of free services solely to Medicare recipients usually provides evidence of out-and-out fraud.

It is important to remember – your Medicare health insurance claim number and Social Security number are one and the same. Do all that you can to keep it secure. Make sure that when you timely review each and every MSN or EOB, you double-check the listed providers to be sure that no one else is using your I.D.

Should the provider listed on the MSN or EOB be unable to resolve your concerns, and you fear you may be a victim of Medicare fraud, you can contact a Senior Medicare Patrol (SMP) counselor of the Health Insurance Counseling and Advocacy Program (HICAP). He or she will ask you for specific details and, if necessary, help forward your case on for formal Medicare fraud investigation.

To find a SMP near you, check online at cahealthadvocates.org/HICAP/index.html or call 800-434-0222. Residents of Los Angeles County can speak with a SMP counselor by contacting the Center for Health Care Rights at 800-824-0780.