Senior Medicare Patrols (SMP) are projects that provide resources and counseling to help counter Medicare fraud, correct errors, and respond to abuse. SMPs help educate and empower Medicare beneficiaries in the fight against health care fraud. SMPs have, for instance, recently sent out alerts specific to COVID-19 vaccine and testing frauds, genetic testing frauds, and hospice frauds.
The Department of Health and Human Services’ Office of Inspector General (HHS-OIG) investigates fraud, waste and abuse in federal health care programs, including Medicare. According to the HHS-OIG’s report to Congress earlier this year, an average of nearly 9,000 calls came into its fraud hotline each month in 2021.
Alex Rosenberg, a lead writer on Medicare subject matter at NerdWallet, recently provided five pieces of advice on how to protect yourself against Medicare fraud. He noted that such fraud is “big business,” and that fraudsters are constantly adapting to ways in which the overall circumstances evolve, such as when a pandemic hits. These shifting circumstances offer opportunity for fraudsters to modify their schemes.
Calling a fraud hotline is one of several actions Medicare beneficiaries can take to protect themselves, Rosenberg writes. See numbers at end of this article. He additionally offered the following five tips to help avoid, detect and report Medicare fraud.
- Protect your Medicare number
Safeguard your Medicare number just as you do your Social Security number and credit cards. Your Medicare number can be used to steal your identity or submit fraudulent medical bills. Share your Medicare number only with trusted health care providers. According to the Centers for Medicare and Medicaid Services (CMS), Medicare will never visit you at home, and a Medicare representative would ask for your Medicare number by phone only if you’ve given permission in advance.
- Beware of free gifts
Fraudsters often try to get your information by offering you something for free in exchange. If you’re asked to provide your medical or financial information and promised a supposedly free gift or service, “that’s something to question, or at least run by a medical professional that you trust,” says an HHS-OIG criminal investigator. Examples of free offers might include COVID-19 tests, genetic testing services, or durable medical equipment like walkers or braces.
- Don’t get talked into unnecessary services
These can run a gamut, including such things as “free” genetic testing for diseases, extra screenings to go along with COVID testing, or even enrollment into hospice care when your health status does not warrant it. If you’re not certain, check with a trusted health care provider to confirm whether a service is necessary and what it might cost.
- Review your health care documents
The statements Medicare (and also your additional insurer, if that’s the case) send you explain what you were billed for, how much Medicare approved and paid for services, what the other insurer paid, and the maximum amount you may owe to health care providers. Watch for any unexpected items or charges on these statements. To help you keep track of everything, you can request a free “My Health Care Tracker” from your state’s Senior Medicare Patrol, or SMP. As noted above, SMPs are provide resources and counseling to help counter Medicare fraud, errors and abuse. Colorado’s SMP can be reached at https://doi.colorado.gov/insurance-products/health-insurance/senior-health-care/medicare/senior-medicare-patrol-smp-medicare or by calling 800-503-5190. [I imagine there’s a way to create this URL link that isn’t so lengthy??]
- Reach out for help
If you’re concerned about potential Medicare fraud, there are free resources you can call for help. Don’t hesitate to call even if you’re not certain. The HHS-OIG encourages beneficiaries to report anything they think is potentially harmful or potentially fraudulent.
There are two main government hotlines:
- Call CMS’ Medicare help line at 800-MEDICARE (800-633-4227).
- Call HHS-OIG’s fraud, waste and abuse hotline at 800-HHS-TIPS (800-447-8477) or submit an online complaint at oig.hhs.gov/fraud/report-fraud.
You can also contact Colorado’s SMP for help (online contact info and phone number given above), and they can refer your issue to the appropriate authorities. You don’t need to contact different agencies. Whoever you call first should be able to coordinate the appropriate response.
