The Three Steps to Guard Against Medicare Fraud

Introduction

• Medicare fraud affects millions of people across the U.S. - regardless of background. It doesn’t just impact the Medicare program. It can prevent patients from getting the care they need.

• If someone gets your Medicare number, they can make fraudulent charges that may exhaust your benefits. These unauthorized claims could result in your number being flagged for overuse. Doctors might even refuse to see you based on this misuse.

• Unfortunately, scammers understand the Medicare system well. Their attempts can be sophisticated, and fraud isn't always easy to spot. That’s why following three simple steps: Protect, Detect, and Report, can help you and others stay safe.

  
  

Understanding Medicare Fraud

• According to the Texas Attorney General's website on Health Care Fraud and Abuse, health care fraud is a deliberate deception or misrepresentation of services that results in an unauthorized reimbursement. Examples of health insurance and medical billing fraud:

  • Billing for services not actually performed

  • “Upcoding,” or billing for a more expensive service than the one actually performed

  • “Unbundling,” or billing each stage of a procedure as if it were a separate procedure

  • Falsifying a patient's diagnosis to justify procedures that aren't medically necessary

  • Accepting kickbacks for patient referrals

  • Waiving patient co-pays or deductibles and over-billing the insurance carrier

• Below you will will find information on how to stay informed and diligent about such scams and avoid them.

Step 1: Protect

Your first line of defense is protecting your personal information.

• Treat your Medicare, Medicaid, and Social Security numbers like credit cards: never share them with strangers.

• Don’t carry your Medicare card unless you need it for a medical appointment.

• Remember: Medicare will never call or visit you to sell anything.

• Only share your information in trusted health care settings.

Step 2: Detect

Even when you're cautious, fraud can still happen. Stay alert by monitoring your records:

• Review your Medicare Summary Notices and Explanation of Benefits (EOBs).

• Watch for:

  • Charges for services you never received.

  • Duplicate charges.

  • Claims for equipment or visits your doctor didn’t order.

• Keep a medical journal or calendar of appointments and services to make comparisons easier.

Step 3: Report

Suspect something isn’t right? Speak up.

• Start by calling your health care provider if something on your statement looks wrong.

• Still unsure or uncomfortable? Contact your local Senior Medicare Patrol (SMP):

  • Call: 1-877-808-2468

  • Visit: SMPresource.org

• You can also report suspected fraud to:

  • 1-800-MEDICARE (1-800-633-4227)

  • 1-800-HHS-TIPS (1-800-447-8477)

Help is available, and your report can protect others too.

Do you or a loved one need help?

The Senior Medicare Patrol (SMP) program, funded by the Administration for Community Living under the U.S. Department of Health and Human Services, provides:

• Free, confidential help.

• Outreach, education, and support through highly trained volunteers.

• Local assistance tailored to your community.

Thank you to the Administration for Community Living | acl.org for gathering this information and allowing us to share with our community.