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Tips for Avoiding Medicare Fraud and Abuse


Medicare fraud is committed when someone knowingly deceives Medicare to get payment or a higher payment than the healthcare provider is entitled to receive. Medicare abuse occurs with practices resulting in unnecessary costs for Medicare. Examples include overcharging for supplies or services, misusing billing codes, or billing for unnecessary services. 

Medicare fraud and abuse are more common than you may think. Fraud schemes can range from individual incidents to widespread group activities. The end result is higher taxes and healthcare costs for everyone. The following tips can help you avoid Medicare fraud and abuse.

Learn to Recognize Medicare Fraud

If you have Original Medicare, it is a good idea to confirm that you actually received the services listed on your Explanation of Benefits or Medicare Summary Notice. Your doctor should not charge for most preventative services, including your annual wellness visit, routinely waive your coinsurance, or offer services or tests you do not need. Be wary of any recommended treatments that seem to not be medically necessary.

Get informed about Medicare coverage rules. Beware if a provider tells you there is a way to get Medicare to cover a service it would not normally cover. Feel free to turn down services you believe are unnecessary, or to get a second opinion. 

Protect Your Medical Information

Do not allow anyone other than your doctor or healthcare providers to review your medical records. Verify the source before you share any personal medical information with anyone. Avoid posting health information online and do not share with organizations not covered by HIPAA. If you store health information online, be sure you are familiar with the website’s privacy policy and terms of service. Shred prescriptions, doctor statements, and insurance forms to safeguard your health information.

Protect Your Medicare Number

Treat your Medicare card and number the same way you would treat a credit card or your Social Security number. Do not show your card or give the number to anyone other than your doctors and healthcare providers. Be wary if someone else asks for your Medicare number, particularly if that person offers free services if you provide the number. 

Be Aware of Medicare Marketing Rules

Insurance companies promoting Medicare Advantage plans are required to follow certain rules. The rules are designed to prevent marketing fraud – misleading consumers about a plan’s benefits or costs. Insurers are not allowed to:

  • Violate federal or state telemarketing laws or the National Do Not Call Registry
  • Call you without first gaining your permission to do so
  • Visit your home without an invitation
  • Engage in cross-selling (selling life insurance or other non-health insurance products in the same appointment)
  • Imply they are contacting you on behalf of Medicare

If you suspect Medicare fraud, waste, or abuse, you have the option to report it to the Office of the Inspector General (OIG). Complaints can be filed online. Our agents are well-versed in what constitutes Medicare fraud and abuse. We are happy to answer any questions you may have on the subject.

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