Medicare fraud poses a significant threat to the integrity of healthcare systems, leading to increasing healthcare costs and undermining trust. Medicare loses an estimated $60 billion annually due to fraud, errors and abuse, but the actual figure is difficult to measure. Medicare fraud and abuse can block people’s access to potentially lifesaving services and benefits. Educating yourself and your loved ones on how to prevent Medicare fraud, errors and abuse is the best place to start.
Understanding Medicare Fraud
Medicare fraud involves the intentional deception or misrepresentation that results in unauthorized benefits. Common examples are as such:
Phantom billing: Charging for services or equipment not provided.
Patient billing: Using a beneficiary’s Medicare number for false claims.
Upcoding: Billing for more expensive services than those actually performed.
Kickbacks: Receiving incentives for patient referrals or prescribing specific products.
Preventing Medicare Fraud
Beneficiaries should be vigilant:
Protect personal information: Never share Medicare numbers with unverified groups.
Review statements: Regularly examine Medicare Summary Notices (MSNs) and Explanation of Benefits (EOBs) for inconsistencies.
Avoid unsolicited offers: Offers for free medical services or equipment may be scams.
Detecting and Reporting Fraud
To identify potential fraud:
Verify services: Ensure all billed services were received and necessary.
Check provider legitimacy: Confirm that providers are reputable/services were authorized.
If fraud is suspected:
Contact providers: Discuss billing concerns with healthcare providers.
Report to authorities: Reach out to the Senior Medicare Patrol (SMP) or the Office of Inspector General.
Senior Medicare Patrol
SMP Hawaii is a federally funded volunteer program that empowers and assists Medicare beneficiaries to prevent, detect and report healthcare fraud. By staying informed and vigilant, we all can play a crucial role in identifying and mitigating dishonest activities.
SENIOR MEDICARE PATROL (SMP) HAWAII
1-800-296-9422 | info@smphawaii.org
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