A few weeks ago we started a discussion on Medicare Fraud. Here is some more information you need to know to keep yourself safe and reduce the risk of fraudulent activity:
- Guard personal information: To commit Medicare fraud, a person must have access to Medicare and Social Security numbers. Seniors shouldn’t share this information with anyone who is offering free goods or services in exchange for a Medicare number. If your Medicare card is lost or stolen, immediately contact Social Security at 1-800-772-1213.
- Closely examine important paperwork. Inspect the accuracy of medical bills, Medicare summaries and explanation of benefits documentation, and periodically review credit reports for unpaid medical bills. Report any suspicious activity immediately. To get a free credit report, call 1-877-322-8228.
When reviewing your Medicare Summary Notice, www.medicare.gov offers these guidelines:
- If you have other insurance, check to see if it covers anything that Medicare didn’t.
- Keep your receipts and bills, and compare them to your notice to be sure you got all the services, supplies or equipment listed.
- If you paid a bill before you got your notice, compare your notice with the bill to make sure you paid the right amount for your services.
- If an item or service is denied, call your doctor’s or other health care provider’s office to make sure they submitted the correct information. If not, the office may resubmit. If you disagree with any decision made, you can file an appeal with Medicare.
- Being aware of any health care providers or equipment suppliers who:
- Offer free consultations services or equipment and ask for a Medicare number for any reason.
- Call on the phone or come door-to-door and say they represent Medicare or the federal government.
- Offer non-medical in-home services or transportation and say they are Medicare-approved.
- Bill Medicare for medical equipment for a senior in a nursing home.
The website www.stopmedicarefraud.gov is full of information about how to guard against Medicare fraud and report suspicious activity.
Reporting suspected Medicare fraud
If a person finds a charge that looks suspicious, contact the provider who billed for the services or goods and ask about the charge. The provider can explain the charge or may realize that it is a billing error.
If the provider does not have an explanation for the charge, the explanation doesn’t match the services or goods received, or the provider cannot be reached, immediately contact Medicare at 1-800-MEDICARE (1-800-633-4227), call the inspector general at 1-800-HHS-TIPS (1-800-447-8477) or email HHSTips@hhs.gov.
As described by Bob LaMendola, a reporter for the Sun Sentinel, South Florida seniors called a special Medicare fraud hotline to give an account of more than 54,000 incidents of alleged Medicare fraud from 2007 through September of 2011. In February 2012, the U.S. government shared the results of the investigations from these calls:
- $58.6 million in overpayments were recovered
- $10.7 million in questionable bills not paid
- $3 million seized from fraudulent firms
- 103 companies kicked out of Medicare
- 106 companies flagged for extra scrutiny in future claims
- 835 fraud investigations started
- 30 cases referred for prosecution
And that is just in South Florida! While seniors can be a target for Medicare fraud, they also have the power to combat Medicare fraud by paying closer attention to the details of their health care bills and taking action when necessary.
Other Resources on Fraud for Seniors:
- Keeping Your Bank Account Safe from Fraud by the Society of Certified Senior Advisors
- Elder Investment Fraud and Exploitation brochure by the Baylor College of Medicine
- National Center on Elder Abuse
- Sequoia Senior Solutions Blog: Attention All Seniors: Medicare Fraud is on the Rise–Protect Yourself
Stanton Lawson is the Co-Owner of Sequoia Senior Solutions. Sequoia’s mission is to ensure a better quality of life for their elderly clients and their families, by providing dependable and affordable in-home care. Sequoia’s focus is to keep you or your loved ones at home and avoid:
- Loss of friends and possessions
- Loss of independence and freedom
- Loss of spirit which is drained by the battles of daily living
Sequoia Senior Solutions, Inc. serves Napa, Sonoma, Marin, Solano, Mendocino, Lake Counties. The main office is located at191 Lynch Creek Way, Suite 102, Petaluma, CA 94954. Email firstname.lastname@example.org Tel: (707) 763-6600 Fax: (707) 763-6607, www.sequoiaseniorsolutions.com.