Learning more during Medicare Fraud Prevention Month
June is Medicare Fraud Prevention Month — and the perfect time to make sure you, or the seniors in your life, are doing all you can to prevent fraud and be prepared for what to do next if you think you’re being scammed.
Medicare loses billions of dollars to fraud, errors and abuse each year, with some estimates as high as $60 billion annually.
Each state has a Senior Medicare Patrol (SMP) program to help Medicare beneficiaries, and the people who care for them, prevent, detect and report health care fraud, errors, and abuse through outreach, counseling and education. Washington’s SMP is part of the Statewide Health Insurance Benefits Advisors (SHIBA) program. Both volunteer-based programs focus on helping Medicare beneficiaries make the best choices for their health and finances.
Common Medicare scams
SMP staffers report seeing a few recurring Medicare-related scams.
- Durable Medical Equipment, like walkers, knee or back braces, urinary catheters, and glucose monitors are billed to Medicare using someone’s ID without their knowledge or approval. Medicare beneficiaries have also frequently received unwanted equipment in the mail.
- Scammers will call beneficiaries claiming to be from Medicare, Social Security or other government agencies and ask for their ID numbers and bank account information to “confirm their benefits.”
- Genetic testing, which is not covered or approved by Medicare, is sent to beneficiaries or billed to Medicare in their name using their ID.
How You Can Help
You are the first line of defense against Medicare fraud. Here’s how to fight it.
- Treat your Medicare card like a credit card. Your Medicare number can be valuable to thieves who want to steal your medical identity or bill Medicare without even seeing you.
- Don’t take advice or offers of medical services from people you don’t know who call, come to your house, or approach you in public.
- Read your Medicare Summary Notice or Explanation of Benefits. Look for services or equipment you didn’t receive, double charges, or things your doctor didn’t order.
- Ask questions and report problems. Call the doctor or company and ask them about mistakes. Call the insurance company if you still have questions. Get help from your local SMP.
- Volunteer. No one cares more about keeping criminals out of Medicare than the people who need it. Become a part of your local SMP program. Help protect your friends and neighbors. If you’re interested in volunteering with the SMP (or SHIBA) programs, call 1–800–562–6900.
Where you can report fraud
If you think you have been the victim of a scam or of fraud, don’t feel bad. It’s happened to plenty of people. That’s why education and awareness are so important.
- Report it to SMP as soon as possible and provide any paperwork, packing slips if you received something, bill statements, or anything that is evidence of what occurred.
- SMPs then submits a report to the Administration for Community Living, which will review the case and forward it to the Office of Inspector General if further investigation is warranted.
- If your Medicare ID has been used to make a fraudulent claim be sure to contact Medicare at 1–800-Medicare to report it.
- For questions about reporting a concern to Washington State Senior Medicare Patrol, you can call the SMP’s Insurance Consumer Hotline at 1–800–562–6900 or submit in writing at insurance.wa.gov/contact-washington-state-shiba-program.
