How to Spot, Prevent and Report Medicare Fraud

Medicare fraud represents a significant threat to the integrity of one of the most crucial healthcare systems serving millions of Americans. It not only diverts essential resources away from those in need but also undermines the trust in healthcare providers and institutions. As agents of Medicare, understanding how to spot, prevent, and report Medicare fraud is paramount in safeguarding the system’s integrity and ensuring that it continues to serve those who rely on it most. This article will provide Agents with the a high-level overview to identify suspicious activities, help clients create best practices to prevent fraud, and navigate the reporting process effectively, thereby playing a crucial role in the fight against Medicare fraud.

How to spot & prevent Medicare fraud & abuse:

As an Agent, you will be the first line of defense for your clients. You will be the one they call first with concerns. You can help spot and prevent Medicare fraud and abuse by assisting the client:

• Compare the dates and services on your calendar with the Medicare statements you receive to make certain you have each service listed and that all the details are correct.
• Checking your claims early.
• Check the receipts and statements you receive from providers for mistakes and call your provider’s office if you think a charge is incorrect. The person you speak to may be able to help you understand the services or supplies you have, or they may realize a billing error was made.
• Knowing what a Medicare health or drug plan can and can’t do before you join. 
• Learning more about Medicare and recent scams.

Examples of Medicare Fraud include:

• A provider that bills Medicare for services or supplies they never gave you, like charging you for a visit you never had or a back brace you never received.
• A provider that charges Medicare twice for a service or item that you only received once.
• A person who steals your Medicare Number or card and uses it to submit fraudulent claims in your name.
• A company that offers you a Medicare drug plan that Medicare hasn’t approved.

If you suspect that Medicare is being charged for an item or service you didn’t receive or your Medicare card or number is stolen, Contact Medicare.gov or Stop Medicare Fraud.