How to Guard Against Medicare Fraud

Published 7:01 pm Tuesday, December 8, 2009

Dear Savvy Senior,

The television program 60 Minutes recently did a disturbing segment on the problem of Medicare fraud, which has raised some questions for me. What are the steps Medicare recipients need to take if they suspect fraud, and what can be done to prevent it from happening?

Suspicious Charlie

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Dear Charlie,

Medicare fraud has been a big problem for many years, but because of the national health care debate going on right now it has gotten a lot more attention lately. Heres what you should know.

Medicare Fraud

Its estimated that Medicare fraud cost taxpayers a staggering $60 billion a year, making it one of the most profitable crimes in America. In a nut shell, Medicare fraud happens when Medicare is purposely billed by greedy doctors, shady health care providers or scam artists for services or supplies that were never provided or received. While there are many types of Medicare fraud, one of the most common schemes is phony billing for durable medical equipment such as wheelchairs, walkers, orthopedic braces, oxygen generators, breathing machines, air mattresses and more.

What You Can Do

The best way for you to spot Medicare fraud is to review your Medicare Summary Notices (MSN) or your Explanation of Medicare Benefits (EOMB) whenever you get them. Be on the lookout for things like charges for medical services or equipment you didnt get, dates of services and charges that look unfamiliar, or if you were billed for the same thing twice. See for help on reading your MSN.

If you do spot any unusual or questionable charges, your first step is to contact your doctor or health care provider. The charge may just be a simple billing error. If, however, you cant resolve the problem with the provider, your next step is to report the questionable charges to Medicare at 800-633-4227. And if you suspect fraud, contact the Department of Health and Human Services Office of Inspector General Fraud hotline at 800-447-8477. Its also a good idea to report it to the Federal Trade Commissions ID Theft hotline at 877-438-4338.

When you call, have the MSN or EOMB with the questionable charges handy because youll need to give them: your Medicare card number; the physician, supplier, and/or facility name where the service was supposedly provided; the date the service was rendered; the payment amount approved and paid by Medicare; as well as the reason you think Medicare shouldnt have paid. And as an incentive, if the suspicious activity you report turns out to be fraud, you may be eligible for a reward of up to $1,000.

How to Protect Yourself

The U.S. Department of Health and Human Services and the U.S. Department of Justice also offers a variety of tips to help you protect yourself from becoming a victim of Medicare fraud, including:

Guard your Medicare and Social Security numbers. Treat them like you would treat your credit cards. If your Medicare card is lost or stolen, report it immediately to Social Security (800-772-1213) who will send you a replacement. Be suspicious of anyone who offers you free medical equipment or services and then requests your Medicare number. Dont let anyone borrow or pay to use your Medicare ID card.Walk away if people approach you in parking lots, shopping centers, or other public areas and offer free services, groceries, transportation, or other items in exchange for your Medicare number. Hang up the phone if someone calls you claiming to be conducting a health survey and asks for Medicare number. Dont give your information to telephone marketers who claim to be from Medicare or Social Security asking for payment over the phone or Internet. Savvy Tips: If you could use some extra help identifying or reporting Medicare fraud or resolving your Medicare billing errors, contact your state SMP program (formerly called Senior Medicare Patrol) which provides free one-on-one counseling and assistance. Visit or call 877-808-2468 for contact information. And for more tips and information on Medicare fraud visit

Send your senior questions to: Savvy Senior, P.O. Box 5443, Norman, OK 73070, or visit Jim Miller is a contributor to the NBC Today show and author of The Savvy Senior book.~ Savvy Senior written by Jim Miller