How to avoid Medicare fraud

Medicare Enrollment Form

Medicare and Social Security benefits are the two most important programs that affect the health and wellbeing of older Americans. Both of these programs are overwhelmingly popular with the public. In 2015, a poll commissioned by the Kaiser Family Health Foundation found that 87% of all Americans viewed Social Security favorably while 77% had a positive view of Medicare. They are the two most popular government programs in America.

The same poll found that many Americans do not think that these programs are sustainable. One of the reasons is the fraud and abuse that is sometimes, perhaps often, found in both programs. Medicare spending in 2016 amounts to a total of $672.6 billion. Medicare will provide health insurance to 57 million Americans who are 65 or older, disabled, or have end-stage renal disease.

Fraud in the Medicare program steals benefits and services that should rightly go to these deserving recipients. You should care greatly about this if you are a taxpayer or a Medicare recipient. Money lost to fraud is not going to pay for your healthcare. Medicare’s own website contains this statement-

“Medicare fraud wastes a lot of money each year and results in higher health care costs and taxes for everyone.”

So, what is Medicare fraud and how can you help prevent it?

If a healthcare provider bills Medicare for services that you never received, that is fraud. If someone else uses your Medicare account or your Medicare card to get supplies, equipment or medical care, it is a crime and a fraud. When a supplier bills Medicare for equipment that you never received or a company uses false information to trick you into subscribing to a Medicare program, those things are also frauds.

Fraud and abuse are paid for by your Medicare premiums or by higher taxes, so you have a direct interest in closing them down. As a Medicare recipient, you are the first line of defense against Medicare fraud. There are some simple steps to take if you want to help fight this problem.

First, guard your Medicare number. Do not give that number to anyone except your doctor’s office or other providers with whom you deal. If you get an unsolicited call asking for your Medicare or Social Security information, hang up! Do not give it to anyone other than your healthcare providers. Dishonest individuals and companies can use that number to bill Medicare fraudulently.

Keep a record of all the doctor visits, lab appointments, hospital stays, receipts for medical equipment and other medical services you receive. Each quarter in which there are charges to your Medicare account, you will receive a statement of all the benefits paid to your providers by Medicare. This statement is called the Medicare Summary Notice or “MSN” and it comes from the Centers for Medicare & Medicaid Services, the CMS. Do not discard this quarterly notice or mistake it for advertising! A married couple may receive two statements, one for each spouse. Remember that if there are no claims for services or equipment during those three months, no MSN will be sent.

Compare your records to the MSN. Your quarterly MSN is a statement showing all the services or supplies billed to your Medicare account during that period. It indicates how much Medicare paid and how much you may owe the supplier. The MSN for that period is not a bill. You do not need to send anyone any money but you should read the statement carefully and compare it to your record of medical expenses. If there are items on the MSN that do not match your records, contact the provider and ask for an explanation. This may be a simple error by the provider or a mistake in your record keeping. If the provider made the mistake, it should be corrected on your next MSN. When you notice that a provider did not bill Medicare for services or supplies that you have received, call it to their attention and ask why. Keep in mind that some services, equipment or treatments may not be covered by Medicare, so check with your supplemental insurer.

The CMS sends this accounting each quarter, but you can also view and download your Medicare Summary Notice on the internet. Go to “” to set up an online account. You will need to supply your Medicare information and choose a password that must be changed at least once every six months. After that you can always check your summary even if you miss it in the mail.

If you suspect that there are fraudulent claims on your MSN, you are encouraged to report it. You can do this by calling the Medicare Hotline at 1-800-MEDICARE or reporting it online to the Office of the Inspector General. Have the facts at hand when you report the suspected fraud. If available, this should include:

  • Your name and Medicare number (you will remain anonymous),
  • The provider’s name and identifying number,
  • What service or item you are questioning,
  • The date of the billed service or item delivery,
  • The amount approved for payment by Medicare,
  • The date of your MSN,
  • Other information you have showing why Medicare shouldn’t have paid for a service or item.

Under certain circumstances, you may be entitled to an award of up to $1000 for reporting fraud. In any case, you will be helping to save the Medicare system for yourself and future generations.

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