Do you have any idea how many people are receiving Medicare benefits? As of October 2021, the total Medicare enrollment was reported to be 63,9664,675 or approximately 18% of the US population. Keep in mind that not all Medicare beneficiaries are 65 or older. Those with disabilities may qualify for Medicare although they are under 65.
Medicare covers many health care services including inpatient hospital care, skilled nursing facility care, health care providers’ services, and so much more. Most beneficiaries who have original Medicare also have a supplement, or a beneficiary may have a Medicare Advantage plan. Medicare is a complex system that involves a great many providers. A huge, complex system that involves a lot of people? Sounds like a scam waiting to happen!
Medicare fraud is committed by scammers who may impersonate someone from your physician’s office. Perhaps they say your doctor wants you to have genetic testing. Perhaps they offer medical equipment (that is covered by your insurance, of course). They ask if you need a knee, back, or arm brace. Then they ask for your insurance numbers.
Consequences of these scams result in medical identity theft and personal financial losses, and can mean poor or harmful health care due to false diagnoses, inaccurate records, or denial of benefits because Medicare thinks the services have been provided.
You know that since this article is about “Medicare Fraud Prevention Week” that medical billing would come up!
Beneficiaries are advised to review explanation of benefits statements, checking them for accuracy and for errors. There are challenges. The statements are complicated, and are presented in medical and insurance jargon that is not familiar to most of us. The statements are bundled so we may be looking at more than one claim. And those are just a few of the challenges!
What can we do?
- Here is a link that will help you learn how to read the explanation of benefit statements.
- What was done when, where, and by whom? Keep a record of your health care for cross-referencing. Get a free Health Tracker here.
- Do not share your personal information.
- Make sure that your physician is involved if you are contacted by someone claiming to represent your doctor. Call your health care provider directly.
Medicare loses an estimated $60 BILLION each year due to fraud, errors, and abuse…losses that affect everyone. Although billing errors may be honest mistakes, they still contribute to the losses so we need to review benefit statements. We also need to be alert to the scammers’ attempts to get our money and/or our personal information.
For 25 years, the Senior Medicare Patrol programs have assisted Medicare beneficiaries, their families, and caregivers with issues involving health care fraud, errors, and abuse. If you think your Medicare number has been misused, if you have an issue, or if you need information, contact your Senior Medicare Patrol office.
Stay safe!
