Medicare fraud is big business, and like most companies, it has adapted to the new conditions of the COVID-19 pandemic.
“The public health emergency has created an opportunity for fraudsters to modify and repurpose existing schemes,” a spokesperson for the Centers for Medicare and Medicaid Services (CMS) said in an email. CMS has seen attackers exploit the widespread demand for telehealth, COVID-19 tests and vaccines as avenues for identity theft and fraud.
The Office of the Inspector General of the Department of Health and Human Services (HHS-OIG) investigates fraud, embezzlement, and abuse in federal health care programs, including Medicare. On average, the fraud hotline received about 9,000 calls each month from April to September 2021. HHS-OIG Report to Congress Spring 2022.
Calling a fraud hotline is one of several steps Medicare beneficiaries can take to protect themselves. Here are five tips to help you avoid, detect and report Medicare fraud.
1. Protect your health care number
In the wrong hands, your Medicare number can be used to steal your identity or send fake medical bills.
“Our main advice is to protect yourself Medicare number just like your social security number [number] and credit cards,” a CMS spokesperson said. “You should only share your Medicare number with trusted health care providers or verified administrators of the COVID-19 vaccine.”
Unexpected callers or visitors who ask for your Medicare information are suspicious, especially if they claim to work for Medicare. According to CMS, Medicare will never visit you at home, and a Medicare representative will only ask for your Medicare number over the phone if you have given permission in advance.
2. Beware of free gifts
Scammers may try to get your information by offering you something free in exchange. If you’re asked to provide your medical or financial information and are promised a supposedly free gift or service, “that’s something to question, or at least have it done by a healthcare professional you trust,” says Isaac Bledsoe, a criminal the HHS-OIG investigator .
Typical examples of free offerings might include tests for COVID-19, genetic testing services, or durable medical equipment such as walkers or braces.
3. Do not insist on unnecessary custody
Some schemes involve billing you for expensive services that you may not need. For example, unscrupulous COVID-19 testing sites may add unnecessary respiratory pathogen panels that can cost more than $500. That’s according to a January 2022 white paper from the Partnership for Healthcare Fraud Prevention, a public-private anti-fraud group.
If you are unsure, contact a trusted healthcare provider to confirm if you need the service and how much it might cost.
4. Review your medical records
Medicare sends statements to explain what you were billed for, how much Medicare approved and paid for the services, and the maximum amount you may owe health care providers. Watch for any unexpected items or charges on these statements.
To help you keep track of everything, you can request the free My Health Care Tracker from your State Health Care Patrol or SMP. SMPs are grant-funded projects that provide resources and advice to combat Medicare fraud, error, and abuse.
My Health Care Tracker documents include sheets for recording information about your health care, instructions for comparing your statements to your bills, and contact information for agencies that can help with problems such as errors or fraud.
5. Ask for help
If you are concerned about possible Medicare fraud, there are free resources you can turn to for help. Don’t hesitate to call even if you’re not sure. Bledsoe encourages beneficiaries to report “anything that you may consider potentially harmful or potentially fraudulent.”
There are two main government hotlines:
- Call the CMS Medicare Helpline at 800-MEDICARE (800-633-4227).
- Call the HHS-OIG Fraud, Waste, and Abuse Hotline at 800-HHS-TIPS (800-447-8477) or submit a complaint online at oig.hhs.gov/fraud/report-fraud.
You can also seek help from your senior medical patrol and they can refer your problem to the appropriate authorities. Visit smpresource.org for contact information.
Whoever you call first can help, and you don’t have to go to separate hotlines. Bledsoe says the various agencies have made coordination a priority, so “there’s no need to call nine different places to report it nine different ways.”
“We can see [issues] immediately and give kind of a quick answer of ‘yeah, that’s what’s not good,'” Bledsoe says. “We may put your Medicare number on a ‘potentially vulnerable’ list to watch for any future bills you may not have requested and we can help you further.”
This article was written by NerdWallet and originally published by The Associated Press.