Preventing Medicare Fraud

Medicare fraud is a severe problem. Medicare loses an estimated $60 billion each year to fraud, errors, and abuse. Every day, these issues affect people across the country and can lead to identity theft and cost you money. Here are some simple tips to help you protect yourself.

Watch for warning signs of a scam.

  • Unsolicited calls, emails, or visits – someone contacting you unexpectedly, claiming to be from Medicare and offering free services.
  • Requests for personal information – a demand for your Medicare number, Social Security number, or other personal information.
  • Pressure to act quickly – any threat that you will lose benefits or face other consequences if you do not comply with a deadline, often by paying or providing personal information.
  • Billings with errors – charges for services or supplies that were not ordered, were never received, or that Medicare already covered.
  • Suspicious websites or mailings – fake websites created to look like official ones but that have inconsistencies, errors, or other odd elements.

 Reduce your risk.

  • Only share your Medicare and Social Security numbers with people you trust.
  • Carry your Medicare card only when you need it.
  • Keep a record of all your medical visits and procedures.
  • Carefully review Medicare statements for mistakes and charges you do not recognize.
  • Trust your instincts and report any suspected fraud.

 Ask for help.

If you have questions about how to protect yourself, need to report fraud, or want help determining whether you have been a victim, Senior Medicare Patrol (SMP) can help.

In 1997, congress approved a new program of Senior Medicare Patrols to empower and assist Medicare beneficiaries, their families, and caregivers to prevent, detect, and report health care fraud, errors, and abuse through outreach, counseling, and education. SMPs are grant-funded projects of the U.S. Department of Health and Human Services, Administration for Community Living.

SMP provides free, unbiased, one-on-one assistance to Medicare beneficiaries, their families, and caregivers. SMP has offices in all fifty states, Washington, DC, Puerto Rico, Guam, and the U.S. Virgin Islands. Local team members teach people how to prevent fraud, assist beneficiaries with billing errors and disputes, and help to report suspected fraud to the correct state and federal agencies.

The most effective way to combat fraud is to prevent it from happening. If you suspect Medicare Fraud, you can reach out to the Massachusetts SMP contact Lucilia Prates at 800-892-0890.

Another important Medicare service is SHINE (Serving the Health Insurance Needs of Everyone). What is SHINE and what can it do for you?

SHINE is a federally funded program helping you navigate Medicare. SHINE counselors are highly trained and will assist you with learning about Medicare and Medicare Savings Programs, whether you are exploring Medicare or are already enrolled.

Medicare Savings Programs (MSPs), formerly known as the MassHealth Senior Buy-In and Buy-In Programs can help with your Medicare costs, such as Part A and/or Part B premiums, deductibles, co-pays, and co-insurance. In Massachusetts, MSPs are managed by MassHealth and there are three different types of MSPs, with various levels of coverage assistance.

A SHINE counselor will help determine your eligibility for an MSP. The recent elimination of asset guidelines for MSPs may mean that you are eligible now when you may not have been eligible before. In addition, a SHINE counselor can review your Medicare coverage to determine if you are in the most cost-effective plan and will help you develop a plan of action to make Medicare work best for your particular circumstances.

To learn more about SHINE, call 978-281-1750 for an appointment with a certified SHINE Counselor at SeniorCare’s Gloucester offices. If Gloucester is not convenient, many local hospitals and councils on aging also offer SHINE services.