Fraud Protection

Six ways to protect yourself from Medicare fraud 

Scammers and fraud perpetrators have devised some very convincing tactics to profit illegally from Medicare. If you think this doesn’t affect you directly, imagine the costs of premiums, copays, and coinsurance rising, or the services you need being harder to obtain. Fraud affects everyone, and it’s important to do your part and help put an end to this crime.

Common Medicare fraud tactics

Medicare fraud can occur in several ways. One way is by putting the wrong diagnosis on a claim. Another way is billing for tests or services an individual didn’t need or receive. Fraud also includes billing home health services for patients who didn’t need it. Additionally, it involves billing Medicare for items like scooters, wheelchairs, or orthotics that weren’t necessary. 

Six ways to protect yourself from Medicare fraud

1. Review each claim you receive from providers and make sure there are no errors. Compare the date of the claim to your appointment on your calendar, and scan each item billed, whether service, testing, or item. Do you see anything strange? Remember, you can call the provider and ask about things you aren’t sure of. 
2. Keep your Medicare number and card safe. Don’t leave your card lying around on tables or places where others can swipe them easily. Be wary of anyone who asks for your Medicare number. The only people who should ask for this are authorized Medicare providers, like your primary care provider, mental health counselor, or specialist. In some cases, when you’re signing up for Original Medicare or switching to a Medicare Advantage plan, an authorized agent may ask for your Medicare number.
3. Be cautious of anything offered as “free.” Some Medicare scams contact you with amazing offers for free consultations, services, equipment, or testing, but want your Medicare number for their records. If they tell you there’s a way to get Medicare to pay for something that seems too good to be true, just walk away or hang up the phone. Be aware that legitimate Medicare Advantage plans may offer things Original Medicare doesn’t, like hearing or vision coverage, transportation, meals, and help with tasks, but you can easily check this information either online or by phone.
4. If you feel any pressure, just say no. Fraud perpetrators use pressure and scare tactics to get you to make decisions quickly. This is never in your best interest. If anyone offers you money or kickbacks, know that this is not allowed. Cold calling or coming to your door is also not allowed. Report Medicare fraud immediately.
5. Coordinate your care across multiple providers. Information shared across multiple providers can help prevent unnecessary tests, procedures, and potential errors. Some examples of coordinating care are joining an Accountable Care Organization (ACO) if you have Original Medicare or joining a Medicare Advantage Dual-Eligible Special Needs Plan (D-SNP) if you have both Medicare and Medicaid, like Sentara Community Complete (HMO D-SNP). 
6. Familiarize yourself with the details of your plan and the rules Medicare plans must follow. Because there are so many options for health care and drug coverage, it’s important to read and understand plan documents. Visit Medicare.gov and individual provider websites, or ask a licensed broker, friend, or family member for help.

Rules every Medicare plan must follow

If you understand what Medicare plans aren’t allowed to do, it will prepare you to recognize an individual committing fraud. 

Medicare plans can’t:

• Come to your house, call you unsolicited, or enroll you over the phone unless you called them—you must agree in writing or over a recorded phone call to learn more about their products
• Offer cash or free meals while marketing, or steer you into one particular plan
• Ask you for payment—they must send you a bill
• Talk to you about their plan in the same locations you receive health care, like exam or hospital rooms
• Market their plans or enroll you during health fairs or educational conferences
  
   

How to report Medicare fraud

If you suspect you have been the victim of fraud, gather as much information as you can, including name and contact information of the individual or business, individuals who can corroborate the information you’re reporting, and any supporting evidence you can provide.

Next, contact one of the resources below:

• Call 1-800-MEDICARE (1-800-633-4227) TTY: 1-877-486-2048 24 hours a day, 7 days a week. 
• If you have a Medicare Advantage plan, call them with any questions or concerns. 
• You can also call the Office of the Inspector General (OIG) at 1-800-447-8477 (TTY: 1-800-377-4950). 
• The Senior Medicare Patrol’s (SMP) Medicare Fraud site reports up-to-date information about scams.

Working with a local Licensed Plan Advisor

A Licensed Plan Advisor can help verify the Medicare plan you choose is legitimate. You don’t pay for their expertise, and they are strictly governed by the Centers for Medicare & Medicaid Services (CMS). A good Licensed Plan Advisor represents multiple plans and can assist you in choosing the best health plan, taking into account your medications, preferred providers, pharmacies, and extra benefits that would best suit your needs. They may even be able to educate you about the most common Medicare scams, and help you understand your rights.

To find a Licensed Plan Advisor, ask your friends for recommendations or check local libraries, places of worship, or community centers for educational Medicare seminars. You can also use the National Association of Benefits and Insurance Professionals search tool by selecting Medicare and entering your state. 

You can also speak to a Licensed Plan Advisor by calling 1-877-550-3285 (TTY: 711). 

October 1–March 31 | 7 days a week | 8 a.m.–8 p.m. 
April 1–September 30 | Monday–Friday | 8 a.m.–8 p.m.

Sentara Medicare is here to help you get the extra benefits you deserve, at no additional cost. We’d love to answer your questions or help you enroll. You can also find more information on our website at www.sentaramedicare.com.

Benefits vary by plan and region. Sentara Medicare is an HMO Dual Eligible Special Needs Plan (HMO D-SNP) that has contracts with Medicare and the Virginia Department of Medical Assistance Services’ Medicaid program. “Cardinal Care” is the brand name of Virginia Medicaid. Y0174_0325_SHPFP_310009_M