How to Avoid and Recognize Medicare Fraud

Medicare fraud is a crime where someone purposely deceives Medicare in order to receive payment when they shouldn’t or receive a larger sum of money than what they should be getting. Anyone is capable of committing this crime including providers, beneficiaries and even doctors.

Learning how to avoid and recognize Medicare fraud can keep you from becoming a victim. If you believe that you or a loved one is a victim of medicare fraud, it is crucial that you report it immediately.

Recognizing Medicare Fraud

Recognizing the actions and behaviors of fraud is the first step in keeping yourself protected from fraudulent activity.

There are many circumstances in which you may fall victim to Medicare fraud. It could happen before you enroll in a plane or even when you are handing information in your doctors office in order to receive care.

However, these are not the only people who are affected by Medicare fraud. Occasionally, someone within the work place may come across improper or wrongful actions and raise questions. They are often wrongfully dismissed from the workplace in an attempt to keep the scheme going without any watchful eyes.

Billing Fraud

If you have Original Medicare you should not be charged for most preventive services and your doctor should never offer unnecessary tests. If your doctor tries to feed you the “the more you get, the cheaper they are” line, proceed with caution and question it.

If you see that there are items or services listen in your claims that you do not recall or have a record of its possible that you or Medicare are being held responsible for payments on services you did not receive. Anyone who notices these kinds of charges should be reporting medicare fraud right away.

If you believe there are incorrect charges in your claims from a provider that you know well. Call their office and ask about it. It may be that you simply don’t understand the the services or supplies you were charged for or that the office made an error they can fix.

Marketing Fraud

There are many marketing scams out there where people are posing as Medicare representatives in order to steal your information and make charges to your account. These acts of theft could cost you thousands of dollars if not noticed and handled appropriately. You should be weary if an agent is pressuring you to join a plan. When discussing plans make sure that you are fully aware and understand what you are being offered and how it will affect your benefits.

Avoiding Medicare Fraud

The whole idea of Medicare fraud and abuse is a scary one but there are things you can do to prevent Medicare fraud and keep yourself protected.

The most important bit of advice is to keep your Medicare and Social Security numbers private and protected. Make sure that that these numbers re only being shares with reliable sources like health care professionals. Ask questions. It is your right to know what services and products you are being charged for. If the provider does not want to share this information with you then you know right away to get out of there fast. Make sure you know how a plan works before you join and educate yourself about Medicare.

Keeping record of appointments, receipts, medications, services and products will help you to keep track of what should and shouldn’t be billed in your claims. You should also keep record of your medications even if they are generic brands. If you are not getting your correct prescription in name or amount report the problem to the pharmacist immediately.

Written by
Jeremy Kaplan

A 50-something year old lifestyle, career, and education blogger based in Atlanta, Georgia. Years of experience in the office setting working with others and still loving it year-after-year.

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