Anti-Fraud

Senior MEDICARE Patrol: Frequently Asked Questions About Medicare Fraud

The Senior Medicare Patrol (SMP) asks the tough questions to stop fraud in its tracks. You may have some questions too. This fact sheet may provide the answers.

You can go a long way in preventing Medicare fraud by remembering these three things:Protect, Detect, Report.

What is the Senior Medicare Patrol?

The Senior Medicare Patrol (SMP) is a group of highly trained volunteers who help Medicare and Medicaid beneficiaries avoid, detect, and prevent health care fraud. SMP volunteers teach Medicare beneficiaries how to protect their personal information, identify and report errors on their health care statements, recognize scams—such as illegal marketing, providing unnecessary services, and charging for services that were not provided—and report fraud and abuse to the proper authorities. There are SMPs in every state and many U.S. territories.

What do I do if I have been scammed?

If you have detected suspicious or erroneous activity on your Medicare Summary Notice or Part D Explanation of Benefits, you should contact your provider or plan. If you are not comfortable calling your provider or plan or you are not satisfied with the response you get, call your local SMP. To find your local SMP, click on “Locate an SMP in your area” at SMP, or call:1-877-808-2468.

How do SMPs prevent health care fraud?

SMPs conduct outreach in their communities by presenting to groups, hosting exhibits at community events, providing one-on-one counseling, and answering calls to the SMP help lines. SMP volunteers also help Medicare and Medicaid beneficiaries who are unable to address fraud by themselves, and, if necessary, SMPs will refer beneficiaries to outside organizations that can investigate.

How can I protect myself against Medicare fraud?

Protect your personal information. Don’t give sensitive information to someone you don’t know. Your Social Security, Medicare, and bank account numbers can be used to defraud you.

You also should avoid sending personal information on the phone or over an unsecured Internet connection. Never purchase items from a website that you’ve found from an e-mail link. If you know the name of an organization you want to do business with, go to the website on your own.

Please Help stop Medicare fraud in its tracks..

on Aging

Don’t give any sensitive information out over the phone.

Beware of people who say they’re from an organization such as Medicare and they need to know your Medicare number. If they truly were from Medicare, they wouldn’t need to ask. Nor would they call or visit your home unless you called them first. Also consider getting on the federal Do Not Call list.

How can I detect fraud and identify errors?

Here are a few simple steps you can take to detect possible fraud.

Keep records of your health care visits, services, and equipment provided, significant lab work, etc. Also, file copies of any bills or notices from insurance companies, doctors, hospitals, pharmacies, etc., as well as canceled checks.

Always review your Medicare Summary Notice or Part D Explanation of Benefits, and compare these notices to your own records and receipts to make sure they are correct.

Look for three things on your billing statement:

1) Charges for something you didn’t get

2) Billing for the same thing twice

3. Services that were not ordered by you or your doctor

Is it okay to dispute information on my Medicare Summary Notice or Part D Exploration of Benefits?

Your health benefits are yours, and it is perfectly acceptable to ask questions of your provider or plan if something does not make sense or may be incorrect. You should contact your provider or plan if:

• You do not understand the charges billed

• You do not think you received a product or service that appears on your statement

• You feel a service was unnecessary

REMEMBER: Only you can stop Medicare Fraud -Birdy