Every year, Medicare loses billions of dollars to fraud, improper payments, and billing errors. While these losses affect taxpayers and the Medicare program itself, they can also have very personal consequences for beneficiaries. Medicare fraud can lead to identity theft, disruption of medical services, and financial headaches that may take months to resolve.
The good news is that there are simple steps you can take to protect yourself.
One of the most effective ways to prevent Medicare fraud is to recognize the warning signs. Be cautious if you receive an unexpected phone call, email, text message, or home visit from someone claiming to represent Medicare and offering free services, equipment, or benefits. Medicare generally will not contact you unexpectedly to request personal information.
You should also be suspicious of anyone asking for your Medicare number, Social Security number, banking information, or other sensitive personal data. Scammers often create a sense of urgency, claiming you will lose benefits or face penalties if you do not act immediately. These pressure tactics are designed to prevent you from taking the time to verify the information.
Another important step is reviewing your Medicare statements. Watch for charges for services you did not receive, medical equipment you never ordered, duplicate billings, or other unfamiliar claims. Even small discrepancies can be signs of a larger problem.
To reduce your risk, treat your Medicare card much like a credit card. Carry it only when necessary and share your Medicare number only with trusted health care providers and authorized representatives. Keep records of your medical appointments, procedures, and prescriptions so you can compare them with your Medicare statements.
If something does not seem right, trust your instincts and ask questions.
Fortunately, help is available through the Senior Medicare Patrol (SMP) program. Created by Congress in 1997, SMP helps Medicare beneficiaries, their families, and caregivers prevent, detect, and report health care fraud, errors, and abuse. Funded through the U.S. Department of Health and Human Services’ Administration for Community Living, SMP programs operate in every state, as well as Washington, D.C., Puerto Rico, Guam, and the U.S. Virgin Islands.
SMP provides free, confidential, one-on-one assistance. Trained staff and volunteers educate beneficiaries about fraud prevention, help review questionable medical bills and Medicare statements, and assist individuals in reporting suspected fraud to the appropriate agencies.
Prevention remains the most effective tool in combating Medicare fraud. If you have concerns about a Medicare-related scam, billing issue, or suspicious activity, you can contact the Massachusetts Senior Medicare Patrol at 800-892-0890.
Another valuable resource available to Massachusetts residents is SHINE (Serving the Health Insurance Needs of Everyone). SHINE counselors provide free, unbiased assistance to people navigating Medicare and related health insurance programs.
Whether you are approaching Medicare eligibility, reviewing your current coverage, or trying to reduce your health care costs, a certified SHINE counselor can help. Counselors explain Medicare benefits, compare plan options, and identify programs that may help lower out-of-pocket expenses.
One program worth exploring is the Medicare Savings Program (MSP). These programs can help eligible individuals pay Medicare premiums and other health care costs. Recent changes in Massachusetts eliminated asset limits for MSP eligibility, meaning some people who previously did not qualify may now be eligible for assistance.
A SHINE counselor can review your situation, determine whether you qualify for savings programs, and help ensure that your Medicare coverage is meeting your needs as cost-effectively as possible.
To learn more about SHINE, call SeniorCare at 978-281-1750 to schedule an appointment with a certified SHINE counselor. Many local hospitals and Councils on Aging also offer SHINE services.
Protecting yourself from Medicare fraud and making informed decisions about your health coverage are important parts of maintaining your independence and financial security. The resources are available—and taking advantage of them can help you get the most from the benefits you have earned.