The 4R’s for Fighting Medicare Fraud
By: Whatcom SHIBA volunteers
Parker is a 78 year old Whatcom County resident. He ordered his Medicare diabetic supplies from a mail order diabetic supply company that overcharged him for a whole year before it was detected. He contacted the State Health Insurance Benefit Advisors (SHIBA) office in Bellingham, WA for advice and support. With the help of a SHIBA volunteer, the billing error was detected in the Medicare Summary Notice and Parker was successfully able to switch to another diabetic supplies vendor.
“There are times where you may suspect you are a victim of Medicare fraud; however, it may due to an undetected billing error. Keep yourself informed and make sure to look at your Medicare summary statements. You can always reorder them from Medicare. Speak to your provider’s billing department for more information,” said Australia Cosby, Whatcom SHIBA Program Coordinator.
In the most recent estimate by the National Healthcare Anti-Fraud Association, Medicare losses have been estimated at $60 billion. These losses are due to fraud, abuse, or waste that can be avoided through personal vigilance, protecting your Medicare number, and learning how to recognize fraudulent activity. These losses could have a significant impact on you – the beneficiary. If you get defrauded by a scooter supplier, then your benefits for getting a scooter in the future gets impacted. If your Medicare number is stolen by identity thieves, that number has been compromised for life. Medicare fraud can also result in inaccurate medical records that include false diagnoses, misleading lab results, and treatments that never occurred. Fortunately, these consequences can be avoided by following the 4 R’s for fighting Medicare fraud.
Maintain a personal health record (PHR) to record your medical history including doctor visits and surgeries, medications, and illnesses. Contact SHIBA or the Northwest Regional Council to get a free copy of a personal health journal specifically designed for senior citizens. Call your local SHIBA office at (360) 788-6533 and talk with a volunteer counselor on how the health journal is the first and most important step in preventing fraud.
a. The quarterly Medicare Summary Notice (MSN) is your most effective tool to monitor your original Medicare account and identify any suspicious activity that you do not recognize. The MSN is issued quarterly for both Part A and B.
b. Compare your personal health records with the claims described in the MSN. Make certain that the services listed in the MSN are accurate and complete. If you find a claim that does not match your records, then it is possible that Medicare got billed for services or items you did not utilize.
c. If you are in Medicare Advantage, then your insurance company is required to send you an explanation of benefits (EOB). You can use the EOB in the same way as an MSN.
Your WA state Senior Medicare Patrol (SMP) is your ally in preventing, detecting, and reporting fraud. Call the WA state insurance hotline at 800-562-6900 to report anything that looks suspicious on the Medicare Summary Notice. If you are enrolled in Medicare Advantage, contact your insurance company immediately. If you are unsure about how to identify fraud in your MSN or EOB, then the local SMP office can help train you to interpret information in the statements.
a. Never give out your Medicare card number to anybody except your health care providers. Medicare cards contain social security numbers, making them as valuable as credit cards to identity thieves.
b. Medicare cards are for life. They do not expire. Do not believe anybody who approaches you in person, via phone or email informing you that your Medicare card has expired. Instead, report that incident immediately to Senior Medicare Patrol.
c. Do not give out Medicare number at any event. If you attend a marketing or educational event, be wary of offers being made in exchange for your Medicare card number. Companies are prohibited from asking for personal identifying information on “sign-in sheets.” Remember to never sign in or display your Medicare card.
Medicare will never call you or ask for personal information such as your Medicare or bank account number. Report any unsolicited call where the caller asks you for personal information.
How to get help
If you have the slightest suspicion of fraud, call the WA state Senior Medicare Patrol immediately at 1-800-562-6900 or Medicare at 800-633-4227 / TTY 877-486-2048.
WAHA manages the Whatcom County Statewide Health Insurance Benefits Advisors (SHIBA) program. SHIBA is part of the Washington State Office of the Insurance Commissioner’s consumer protection services. SHIBA provides free, unbiased, and confidential help with Medicare and health care choices. The Whatcom SHIBA program is a grantee of the Senior Medicare Patrol program. If you are interested in becoming a Senior Medicare Patrol volunteer please contact Australia Cosby at 360-788-6533.