Our Ask An Angel correspondent is Arlene Petersen, Certified Senior Advisor and Life Care Navigation Specialist in the area of senior home care.
Q. How can I make sure I’m not lured into a Medicare scam? I get all kinds of calls about it all the time.
A. It seems like we are reading about many types of fraud in our newspapers these days. Our health benefits are not immune to this type of activity, so we need to be aware of how to detect a problem. The U.S. Administration on Aging reports that every year taxpayers lose billions of dollars to fraud in health care. That’s me and you! Basically, fraud usually occurs when someone charges you for services you have not received. It can involve any type of medical provider.
The official government website for Medicare, www.Medicare.gov, has listed several points to consider when identifying and reporting fraud. Here are some tips that may help to reduce potential Medicare fraud:
– If you are uncertain about your statement, contact your service provider first.
– If you notice an error on your Medical Summary Notice (MSN), contact your provider. Legitimate errors do occur and can be easily corrected.
– Check the dates of service provision for their accuracy.
Did you receive double billing? There may be reasons you receive two bills, i.e., one provider offers the service and another simply reads the x-rays, MRI, or other tests. Check it out just to be sure.
– Is the address of the provider different than the office you received service?
– Do you recognize the name of the doctor who provided the services?
Some of these can be clerical mistakes and easily explained, yet at times, some of the points sited above may actually be a form of provider fraud. A simple phone call may eliminate your concerns and prevent this fraud.
From the same government website, here are some tips for reducing the potential fraud cases that are so rampant in our system:
1. Never give your Medicare number to anyone, except your doctor or other Medicare provider.
2. Don’t allow anyone, except your medical provider, to review your medical records or recommended services.
3. Don’t contact your doctor to request a service that you do not need.
4. Do be cautious when you are offered free testing or screening in exchange for your Medicare card number.
5. Do be cautious of any provider who states he or she has been endorsed by the Federal Government or by Medicare.
6. Do avoid a provider of healthcare items or services who tell you that the item or service is not usually covered, but they know how to bill Medicare to get it paid.
7. Do use a calendar to track your appointments, admissions, discharge dates, and what tests or x-rays you get then compare this with the MSN.
It is up to us, the general public, to scrutinize our bills and review service recommendations, billing inconsistencies, unusual office locations, “too good to be true” offers, etc. If we all regularly question what is happening with our service providers, we should be able to greatly reduce fraud in our medical insurance programs.
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