Latest news with #SeniorMedicarePatrol
Health Line
9 hours ago
- Health
- Health Line
How to Identify and Report Medicare Fraud
Medicare fraud is when a person knowingly submits false information or misuses the Medicare system to achieve personal financial gain or to receive benefits for which they are ineligible. Medicare has numerous official channels for reporting suspected fraud. While estimates vary, the Senior Medicare Patrol reports that Medicare losses due to fraud could be as high as $60 billion annually. What's clear is that Medicare fraud and abuse are pervasive, put significant stress on the system, and have the ability to affect the care that older adults receive. Medicare fraud can be perpetrated by various people and organizations, including healthcare providers, such as doctors, clinics, or hospitals, as well as criminal groups and individuals. In this article, we'll discuss what Medicare fraud is, how to identify it, and where to report it. Common types of Medicare fraud Medicare fraud can take many forms and can affect both beneficiaries and providers. Common types of Medicare fraud include: Medical identity theft: This can take many forms. It could involve using another person's Medicare number to obtain healthcare services or benefits or using a physician's identifier to fill prescriptions. Billing for unnecessary services: Under Medicare regulations, many procedures only receive coverage if they're considered medically necessary. If a provider intentionally bills for unnecessary procedures, it is a form of fraud. Kickbacks: Kickbacks are when a provider receives some form of compensation in exchange for referrals or utilization of services. An example would be a doctor who receives personal payment from a lab facility for referring patients. Billing for services never rendered: This is when a provider bills Medicare for services or procedures it never actually administered. It may involve falsifying documentation to create the appearance of authenticity. Upcoding and unbundling of services: Upcoding involves billing for services at a higher complexity than those actually rendered. Unbundling involves submitting bills in a staggered fashion to maximize payment when Medicare requires that those bills be submitted together to reduce costs. Vigilance is important in matters related to Medicare and billing. Understanding what to look for can help you identify fraud in practice. As a consumer and Medicare beneficiary, be sure to regularly check your Medicare claims and keep an eye out for irregularities. Look for: unfamiliar charges on your Medicare summary notice line items for services you didn't receive bills from unfamiliar providers If you have regular contact with a healthcare professional, facility, or other provider, you may notice trends that could signal potential fraud. These include: unusual billing patterns geographic anomalies suspicious documentation patient complaints How to report Medicare fraud If you suspect fraud may be occurring with a given provider, it's important to notify the Centers for Medicare & Medicaid Services (CMS). Reporting suspected fraud, waste, or abuse in Medicare programs is key to protecting both the integrity of the Medicare system and the individuals it serves. You can do this in various ways: Contact Medicare by phone at 800-MEDICARE (800-633-4227). Submit a complaint online with the Office of Inspector General of the Department of Health and Human Services (HSS-OIG). Contact the HSS-OIG by phone at 800-HHS-TIPS (800-447-8477). Individuals with a private Medicare plan, such as a Medicare Advantage (Part C) or Part D plan, can also reach out to the Investigations Medicare Drug Integrity Contractor (I-MEDIC) with fraud complaints. You can reach I-MEDIC by phone at 877-772-3379. Before filing a complaint, it's important to collect all relevant documentation to back up your claim. This includes: your Medicare number the subject of your complaint, including information that can identify them the service in question and the date of receipt the cost of the service Summary Fraud and abuse cost Medicare billions of dollars each year. Reporting Medicare fraud is important for protecting individuals and maintaining the integrity of the Medicare system. Always guard your Medicare card, number, and other personal medical information. Additionally, review your Medicare summary notices routinely for irregularities that suggest inappropriate billing. If you think you were billed incorrectly, consider contacting Medicare for clarification. While errors happen, and not all errors are due to fraud, it's best to be safe and report your concerns. The information on this website may assist you in making personal decisions about insurance, but it is not intended to provide advice regarding the purchase or use of any insurance or insurance products. Healthline Media does not transact the business of insurance in any manner and is not licensed as an insurance company or producer in any U.S. jurisdiction. Healthline Media does not recommend or endorse any third parties that may transact the business of insurance.
Yahoo
05-06-2025
- Health
- Yahoo
You ask, we answer: Do I need to replace my paper Medicare card with a plastic card?
In June, Wisconsin consumers contacted Public Investigator with a question: Will my paper Medicare card expire in 2025? The individuals said they received several calls about replacing their paper Medicare card with a plastic card. The callers, who contacted them using regional Wisconsin phone numbers, claimed that their paper insurance cards will expire this year. Callers claimed to be affiliated with the Wisconsin Department of Administration and Centers for Medicare and Medicaid Services. But experts say such outreach is a common ploy for stealing people's personal information. Here's what you need to know about the scam targeting consumers across the United States. Medicare cards are always paper. "If someone calls claiming it will be switching to a plastic card, that is a scam call," said Lisa Schiller, senior director of investigations at the Better Business Bureau. If you receive a plastic Medicare card in the mail, it is not coming from the Centers for Medicare and Medicaid Services, or CMS. It is likely being sent by a scammer attempting to steal your personal information or identity. It is very rare that a consumer is contacted by phone to make changes to their Medicare card. A person's card needs to be replaced only if it is lost, damaged or the consumer believes someone else is using their card number. The Senior Medicare Patrol, an organization that works with Medicare beneficiaries to detect and report health care fraud, advises consumers to hang up if contacted by an individual offering assistance to change or renew their Medicare card. If you receive a call requesting information about your Medicare or social security number, it is recommended that you do not answer questions. Instead, write down the phone number and report the details of the call to the Medicare Fraud and Abuse office or the local Senior Medicare Patrol line at 888-818-2611. Scammers use a variety of different excuses to collect personal medical information. Commonly, experts say, they offer someone discounted or free durable medical equipment, genetic testing, health supplies or health services. They might tell you that your Medicare plan has limited coverage or plans to deny a medical condition that you have. Some scammers contact consumers through postcards, social media or print advertisements or radio commercials and encourage them to contact the organization for more information. When consumers reply to these scammers by phone or a scam caller contacts them directly, they might be repeatedly asked to share their Social Security number or Medicare card number before ending the call. If you believe a scammer has successfully accessed your personal information or Medicare card number, contact a fraud hotline and check your recent Medicare statements to see if they align with recent health services you have received. If you identify a significant number of unfamiliar charges, there is a high likelihood that someone has accessed your card information. Several organizations field complaints about Medicare and health care fraud in Wisconsin and across the United States. If you believe a scam caller contacted you or you shared personal information with a potential scammer, you can contact the following agencies: Call the Senior Medicare Patrol at 888-818-2611. Alert the Medicare Fraud Hotline at 1-800-MEDICARE (1-800-633-4227) or Report Medicare Fraud online. Report your experience to the Better Business Bureau at Medicare officials say consumers can protect themselves from medical identity theft by not giving their Medicare card, number or social security number to anyone but their doctor, State Health Insurance Assistance Programs (SHIP) or insurers acting on their behalf. Consumers are also advised to not sign up for or join a Medicare health plan over the phone unless they made the initial outreach and asked for help. In these cases, consumers should always double check to ensure that they are contacting the correct office or a phone number listed on Under no circumstance will Medicare officials call a consumer to sell them services, the agency says on their website. If a person visits your home claiming to be affiliated with Medicare and able to provide deals or services, that is a scam. According to CMS, it is rare that Medicare agents call and ask for personal information unless a consumer has recently signed up for a new health plan, reported fraud or contacted Medicare with an inquiry. If you receive a scam call, file a complaint at You can also report unwanted calls and register your telephone numbers at the National Do Not Call Registry at File complaints with the FCC by going to Tamia Fowlkes is a Public Investigator reporter for the Milwaukee Journal Sentinel. She can be reached at tfowlkes@ Government corruption. Corporate wrongdoing. Consumer complaints. Medical scams. Public Investigator is an initiative of the Milwaukee Journal Sentinel and its sister newsrooms across Wisconsin. Our team wants to hear your tips, chase the leads and uncover the truth. We'll investigate anywhere in Wisconsin. Send your tips to publicinvestigator@ or call 414-319-9061. You can also submit tips at This article originally appeared on Milwaukee Journal Sentinel: Calls about replacement plastic Medicare card? They're a scam
Yahoo
02-06-2025
- General
- Yahoo
June 2-8 is Medicare Fraud Prevention Week
The Senior Medicare Patrol launches a mobile app to fight fraud! WASHINGTON, June 2, 2025 /PRNewswire/ -- The fourth annual Medicare Fraud Prevention Week kicks off on Mon., June 2. Led by the Administration for Community Living's (ACL) Senior Medicare Patrol (SMP) program, the national observance was established to raise awareness about Medicare fraud and educate individuals and communities about protecting themselves. This year's event will debut a brand-new mobile app, "SMP Medicare Tracker", that will allow users to learn about scams through games and alerts, read news, and report fraud. Another feature will be the "SMP My Health Care Tracker" where users can keep track of what happens during health care appointments to then compare to their Medicare statements for accuracy. "Each year, Medicare loses an estimated $60 billion due to fraud, errors, and abuse," says the director of ACL's Office of Healthcare Information and Counseling, Rebecca Kinney, who oversees the national SMP program. "Fraud can happen to anyone, and its impact on individuals and families can be dramatic, so it's vital to make people aware of the latest scams and prevention tips and tools." Common scams may look like: Receiving bills for services or supplies that weren't ordered or were never received. Getting orders for tests or services that are unnecessary. Someone calling pretending to be from Medicare or your doctor's office, needing your Medicare number for any reason. With offices in all 50 states, Washington, D.C., Puerto Rico, Guam, and the U.S. Virgin Islands, SMP provides free, unbiased one-on-one assistance to Medicare beneficiaries, their families, and caregivers. Local team members teach people how to prevent Medicare fraud and assist beneficiaries with billing errors and disputes. If a beneficiary suspects they have been a victim of Medicare fraud, a team member will work with them to report it to the correct state and federal agencies. For more information on preventing fraud and to find a local SMP office, visit and follow the SMP National Resource Center on Facebook to learn about the most recent scams. About Senior Medicare Patrol Senior Medicare Patrol (SMP) is a national program of the Administration for Community Living, an operating division of the U.S. Department of Health and Human Services. SMP works with Medicare beneficiaries, family members, and caregivers to prevent, detect, and report health care fraud, errors, and abuse. SMP has offices in all 50 states, Washington, D.C., Puerto Rico, Guam, and the U.S. Virgin Islands. For more information on the program's history, funding, and outcomes, visit Media Contact:SMP Resource Centerbbauer@ Photos: Press release distributed by PRLog View original content: SOURCE SMP Resource Center Error in retrieving data Sign in to access your portfolio Error in retrieving data Error in retrieving data Error in retrieving data Error in retrieving data
