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Protect Yourself From Medicare Fraud

by Jeff Dailey
Preventing Holiday Shopping Identity Theft

Most doctors, pharmacists, plans, and other health care providers who work with Medicare are honest. Unfortunately, there a few that are dishonest. Medicare is working with other government agencies to protect you and Medicare. Medicare fraud happens when Medicare is billed for services or supplies you never got. Medicare fraud costs Medicare a lot of money each year. You pay for it with higher premiums. Protect Yourself From Medicare Fraud

The following are examples of possible Medicare fraud:

  • A health care provider bills Medicare for services you never got.
  • A supplier bills Medicare for equipment different than what they provided to you. Someone uses another person’s Medicare card to get medical care, supplies, or equipment.
  • Someone bills Medicare for home medical equipment after it has been returned.
  • A company offers a Medicare drug plan that hasn’t been approved by Medicare.
  • A company uses false information to mislead you into joining a Medicare plan.

If you believe a Medicare plan or provider has misled you, call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. When you get health care services, you may want to save the receipts you get from providers. Use your receipts to check for mistakes on statements you get. These include the Medicare Summary Notice if you have Original Medicare, or similar statements that list the services you got or prescriptions you filled.
If you suspect billing fraud, here’s what you can do:

  • Contact your health care provider to be sure the bill is correct.
  • Call 1-800-MEDICARE
  • Call the Inspector General’s hotline at 1-800-HHS-TIPS. (1-800-447-8477). TTY users should call 1-800-377-4950. You can also send an email to HHSTips@oig.hhs.gov.

Fighting Fraud Can Pay
You may get a reward of up to $1,000 if you meet all these conditions:

  • You report suspected Medicare fraud
  • The Inspector General’s Office reviews your suspicion
  • The suspected fraud you report isn’t already being investigated
  • Your report leads directly to the recovery of at least $100 of Medicare money

For more information, call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
Note: For your protection, your full Medicare number is no longer printed on your Medicare Summary Notice. The first 5 digits of your number are replaced with “Xs.”
How Medicare Protects You
Medicare works with other government agencies to protect Medicare from fraud and to protect you from identity theft. With help from honest health care providers, suppliers, law enforcement, and citizens like you, Medicare is improving its ability to prevent fraud and identity theft. Some dishonest health care providers have been removed from Medicare, and some have gone to jail. These actions are saving money for taxpayers and protecting Medicare for the future. Below and on the next page are other ways Medicare is working to protect you.
You Are Protected from Discrimination
Every company or agency that works with Medicare must obey the law. You can’t be treated differently because of your race, color, national origin, disability, age, religion, or sex. If you think that you haven’t been treated fairly for any of these reasons, call the Department of Health and Human Services, Office for Civil Rights for your state, or call toll-free 1-800-368-1019. TTY users should call 1-800-537-7697. You can also visit www.hhs.gov/ocr for more information.
The Medicare Beneficiary Ombudsman
An “ombudsman” is a person who reviews issues and helps to resolve them. The Medicare Beneficiary Ombudsman shares information with the Secretary of Health and Human Services, Congress, and other organizations about what works well and what doesn’t work well in Medicare. The Ombudsman helps improve the quality of the services and care you get from Medicare by reporting problems and making recommendations.
How Does the Medicare Beneficiary Ombudsman Help You?
The Ombudsman makes sure information is available to all people with Medicare about the following:

  • Your Medicare coverage
  • Information to help you make good health care decisions
  • Your Medicare rights and protections
  • How you can get issues resolved

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