Medicare Fraud Prevention Week focuses on the actions everyone can take to prevent Medicare fraud, waste and abuse. Medicare Fraud Prevention Week runs from June 3 through June 9. Medicare Fraud Prevention Week is sponsored by the National Senior Medicare Patrol program, a federally funded program of the Administration for Community Living, known as the SMP.
The mission of the SMP is to educate Medicare beneficiaries about Medicare fraud, waste and abuse. Medicare beneficiaries can learn how to protect themselves and their families from Medicare fraud by joining the SMP program every day during the Medicare Fraud Prevention Week. In New Jersey, connect with the Senior Medicare Patrol of NJ on its website: seniormedicarepatrolnj.org.
Why Is This Week Important?
Medicare loses an estimated $60 billion each year due to fraud, waste and abuse. Every day, issues related to these problems affect people across the country, often costing them time, money and well-being. Medicare-related errors contribute to this annual loss even though errors can be honest healthcare billing mistakes. However, repeated errors by a doctor or provider could be considered a red flag of potential fraud or abuse if not corrected.
When people steal from Medicare, it hurts us all and is big business for criminals. Some common examples of fraud, waste or abuse could include:
- Charging for services or supplies that were never provided
- Upcoding, billing a higher code for services provided so that providers can receive more money from Medicare
- Double billing
- Prescribing or providing excessive or unnecessary tests and services
Who Pays for Medicare Fraud?
Medicare fraud, waste and abuse is paid for by all taxpayers. It is your money. It increases the cost of Medicare and jeopardizes the Medicare program.
Falling prey to healthcare fraud may mean that your Medicare number has been “compromised” as a result of medical identity theft. Stealing from Medicare leaves less available funds for legitimate Medicare services now and those needing Medicare in the future.
How to Take Part in the Week
The most effective way to stop Medicare fraud from occurring is to prevent it from happening in the first place. Learning how to prevent it and then sharing what you learn with others is how Medicare beneficiaries, caregivers, family members, partners and professionals, and the whole community can participate during Medicare Fraud Prevention Week.
If you are a Medicare beneficiary, start the week by learning how to read your Medicare statements. Read your Medicare Summary Notice (MSN) or Explanation of Benefits (EOB) carefully. Even though an MSN may say “This is Not a Bill,” it is a statement of the cost of services that Medicare has paid on a beneficiary’s behalf.
Remember the Three Steps From the SMP: Prevent, Detect, Report!
Prevent: Learn how to read your MSN or EOB. By reading your statements carefully, a beneficiary can discover any discrepancies in their billing. A beneficiary can also call their state SMP or go to the SMP website to learn how to best protect themselves and their families.
Detect: When reviewing an MSN or EOB, look for services, products or equipment that was not received, double charges, or items your doctor did not order.
Request and use a Health Care Tracker from the SMP of NJ to keep track of all of your medical appointments and all the services you received. Then compare the information you recorded with what is printed on your MSNs and/or EOBs. The SMP of NJ will be happy to mail you a tracker. Call us at 732-777-1940 to request a tracker.
If you find items of concern, call the doctor or company in question and ask them about potential mistakes. Call your insurance company if you still have questions.
Report: Call or email the SMP of NJ if you believe that you have experienced health care fraud, waste or abuse.
Caregivers, help by educating yourself and your clients or loved ones on how to prevent and detect health care fraud, errors and abuse. Be on the lookout for things like boxes of knee braces (known as durable medical equipment, or DME) lying around the house. This is a common scam and may mean your client or loved one has been a victim. Remind your clients or loved ones to never give out their Medicare number or other personal information over the phone.
Families, help by talking to your loved ones about protecting their Medicare number just as they would a credit card number. Encourage them to check their Medicare statements for fraud, waste or abuse. Help your loved ones create a Medicare account at Medicare.gov to access their Medicare claims online or remind them to open and review their statements when they come in the mail every three months.
Health care providers, help by talking to patients about healthcare-related scams such as those related to durable medical equipment, genetic testing, or new, plastic Medicare cards that may contain a chip, just like a credit card. Reassure them that your office and their other doctors’ offices are not going to call to offer them services or equipment. Teach them that products and services should only be ordered by doctors they regularly visit, and that needed medical items should never be ordered through TV ads or unsolicited calls.
Lastly, as a community, help by looking out for your older neighbors. If you overhear someone talking about Medicare, do not be afraid to give information about the state SMP. Encourage those you know to talk to a trusted source about their Medicare questions and tell your neighbors about the most recent Medicare scams. Consider volunteering with your state SMP so you can help spread the word about preventing Medicare fraud, waste and abuse. Or contact the SMP of NJ to come to your group or organization for a presentation on Medicare fraud. These presentations are free and can take place anywhere in NJ. Schedule a presentation by calling the SMP of NJ at 732-777-1940.
Charles Clarkson is the project director, Senior Medicare Patrol of New Jersey.
