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Prevent Medicare Fraud: Information for Providers & Their Patients

Many con artists and scammers see the COVID-19 pandemic as an opportunity to commit healthcare fraud. Providers can help prevent Medicare fraud and protect their patients from identity theft with the information below.


Prevent Medicare Fraud: Information to Share with Patients

The negative effects of Medicare fraud include higher deductibles and co-pays for Medicare beneficiaries, cuts to services covered by the program, and increased healthcare costs and taxes for all. You can help prevent Medicare fraud by making your patients aware of this crime and providing them with resources regarding how to avoid Medicare scams.


Here are some tips and reminders to share with your patients:

  1. Never give your Medicare Number or Medicare card to anyone other than participating Medicare doctors/pharmacists or a person you trust who may work with Medicare on your behalf. Protect it like you would your Social Security card and SSN.

  2. Never accept offers for free medical care in exchange for your Medicare Number or other personal data. For example, scammers might claim they will send you a coronavirus test or masks if you give them this information – don’t do it.

  3. Always check your Medicare claims and Medicare Summary Notices (MSNs) as early as possible for errors.

  4. Know that Medicare:

  5. Will never call you (or text you, email you, etc.) to verify your Medicare Number.*

  6. Will never call you to sell you something.

  7. Will never visit your home.

*If anyone calls you and asks for your personal information over the phone, just hang up.


Here is a list of resources to share with your patients:

  1. 5 Ways Medicare Theft Affects You Directly

  2. How to Spot Medicare Fraud

  3. 4 R’s for Fighting Medicare Fraud

  4. Examples of COVID-19 Medicare Scams

  5. Latest Medicare Scam: Chip Card Offer

  6. Common Medicare Enrollment Schemes – used especially during the Open Enrollment Period (October 15 – December 7).

  7. Senior Medicare Patrols (SMPs) – patients and their families/caregivers can find help preventing, detecting, and reporting Medicare fraud from their local SMP program.

Patients should call 1-800-MEDICARE if they suspect Medicare fraud. The Medicare.gov website states that patients should have this information ready when reporting Medicare fraud:


  1. “Your name and Medicare Number.

  2. The provider’s name and any identifying information you may have.

  3. The service or item you’re questioning and when it was supposedly given or delivered.

  4. The payment amount approved and paid by Medicare.

  5. The date on your Medicare Summary Notice or claim.”

Prevent Medicare Fraud: Information for Providers & Practices

Providers should also take care to avoid negligent activity regarding Medicare participation within their practice, which can result in serious legal and financial consequences.


Start with the credentialing process – EligibilityOne can manage the Medicare provider enrollment and revalidation processes for you, and conduct a health plan audit, so you can rest assured your providers are compliant with the requirements for participating in this complex program.

For more information on how to prevent Medicare fraud, enroll new providers, or revalidate existing providers, please contact us here.

 

By Stephanie Salmich

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