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Fraud & Abuse

 

Health care fraud affects all of us. It impacts the quality of health care we get and results in higher costs. Reducing Medicare fraud helps ensure that younger generations like your grandchildren will have Medicare when they need it.

What can you do?

Knowing what to look for can help you protect your identity and benefits. Be suspicious of:

  • People who offer money or gifts for health care services
  • Bills for services or equipment you didn’t get
  • Shipments of medical supplies you didn’t order
  • Someone using your Medicare card to get medical care, supplies or equipment
  • People offering you free gifts or services in exchange for your Medicare or health plan member ID number

Protect yourself from fraud

You can take steps to protect your benefits and your identity

Know who you’re sharing information with

Don’t be afraid to ask questions if someone asks for your personal information. Never give out your Social Security, Medicare, health plan numbers, or banking information to anyone you don’t know. Medicare will not call you to ask for this information, and neither will we.

Make sure your plan statements are correct

Report when you’re billed for something that doesn’t appear correct or that you didn’t receive. Carefully review statements and:

  • Make sure you received the services or items billed
  • Check the number of services billed
  • Ensure the same service has not been billed more than once
  • Verify the copayment amount is correct and the actual amount you paid

Free services don’t not require you to give personal information

Talk with your doctor about the items and services you need. If someone offers you a free service, they will not ask for your plan, Social Security or Medicare number.

Remember – If the deal is “too good to be true,” it probably is!

Report concerns to us

If you see something suspicious or have a question about your plan statement, call Member Services at the number on your ID card.

Review Medicare fraud, waste and abuse alerts

There are many different types of fraud, waste and abuse

It’s important to be able to identify these issues and protect your identity and benefits.

Online theft of personal information

People may try to steal your personal or Medicare information online. They can harm you financially and may disrupt your Medicare benefits. It’s not always easy to distinguish an important email about your benefits from an online scam. An email may say there’s a problem with your account or ask for updated information to continue your Medicare coverage.

What you can do

  • Delete or ignore suspicious emails. Don’t click on links or download attachments in them.
    • Legitimate email addresses end in .com, .org, or .gov
    • Beware of emails with misspellings or bad grammar
  • Do not provide personal or financial information via email.
  • Update your antivirus software regularly, and set up filters for junk or spam email.
  • When in doubt, call us using the number on your ID card. You can also call 1-800-MEDICARE (TTY users should call 1-877-486-2048) anytime, or visit Medicare’s website.

Visit the Medicare website

Scams to convince you to change your coverage

If you’re covered by both Medicare and Medicaid you can change your health plan or drug coverage whenever you need to. However, scammers might try to get you to sign up for a plan that doesn’t fit your needs.

What you can do

  • Only make changes that are right for you.
  • Understand the differences between your current plan and new coverage options.
  • Do not change your coverage if someone calls or visits your home without permission.
  • Review your plan statements and other mailings to make sure no one changed your plan without you knowing.

Fake discount cards for prescriptions

Discount prescription drug cards can save you money. But some scammers use fake discount cards to steal your identity or your money. Real discount cards are free – you should never pay for one.

What you can do

  • Talk to someone you trust, like your health plan or pharmacist.
  • If you’re enrolled in Medicare Part D, most of your prescription drugs are already covered.
  • Avoid discount cards that ask for money or claim to replace Medicare.

Telemarketing scams

Many legitimate businesses engage in telemarketing. But criminals can also use live or recorded calls to try to steal your identity. Medicare will not call to ask for your bank account number, Social Security number, Medicare ID or health plan ID number. HealthSpireSM won’t either.

What you can do

  • Hang up on recorded messages. Do not press any keys or numbers when prompted—even if it is to take your name off their list.
  • Never give your personal information to someone you don’t know.
  • Report suspicious numbers to the Federal Trade Commission (FTC) by calling 1-888-382-1222.

Online pharmacy scams

Most online pharmacies are not safe or legal. They might send you medication that is tampered with, expired or fake. They might use your personal information to steal your identity.

  • Only order from online pharmacies in your health plan’s pharmacy network.
  • Don’t click on links in e-mails or pop-up advertisements on the Internet.
  • Don’t order from pharmacies outside the United States.
  • Report pharmacies that:
    • Offer prescription drugs without a prescription
    • Won’t accept your prescription insurance card as a form of payment

Home health agency fraud

Home health services are only medically necessary if you’re confined to your home. Some home health agencies may take advantage of you and commit fraud.

What you can do

  • Make sure that your home health services have been authorized by your doctor.
  • Verify that you are only billed for the number and type of home health visits that you’ve received.

Medical transport services fraud

Medical transport services are sometimes necessary. Some companies may bill Medicare for services that you may not have received.

What you can do

  • Basic Life Support, or BLS, includes oxygen, cardiac (heart) monitoring and more. If your bill shows BLS but you did not receive these services – report it!

Medical supplies fraud

Medicare does not sell or mail medical supplies. If you receive medical supplies that you or your doctor did not order, you might be the target of a fraud scheme.

What you can do

  • Refuse medical supplies that you did not order.
  • Return unordered medical supplies that are shipped to your home. Report the company that sent you these items.

Lab test fraud

Genetic tests must be ordered by your doctor to be covered by Medicare. Some labs try to offer a “free” test in order to get your Medicare information. They may try to steal your identity or submit a fraudulent bill.

What you can do

Before you agree to genetic testing, be sure:

  • The test is ordered by your doctor.
  • The test is medically necessary and covered by your plan.