Mr. O’Malley, a dialysis patient, was receiving treatment when he was approached by a woman offering him free supplies, including a monitor, test strips and lancets. He told her he was not interested and did not need the supplies. But a week later a package arrived at his house.
Mr. O’Malley concluded that the sender had obtained his address and
Medicare number and was billing
Medicare fraudulently for the supplies. He reported the incident immediately.
EXAMINE YOUR STATEMENTS If you have traditional Medicare, you receive statements quarterly. Review them carefully, looking for doctor visits that never happened, unfamiliar
medical provider names, and supplies and equipment you never received.
You can check claims on your account online as soon as they are posted if you sign up at
MyMedicare.gov. Seniors who are not comfortable with the Internet can assign a caregiver the right to check statements online.
If you are part of a
Medicare Part D prescription
drug plan, usually you will receive a monthly explanation of benefits. Check these carefully.
If you find something unusual, call your doctor or medical provider first. It may be a simple error. If not, report it immediately. (See below.)
AVOID ENROLLMENT HAZARDS Beginning Nov. 15,
Medicare recipients can sign up for or change plans. This period is also when criminals peddle bogus
Medicare and
Medicare D prescription drug plans. Many try to tempt seniors with offers of services and products that are not actually covered by Medicare.
Check any insurance plan you are considering on the plan finder at Medicare.gov. If you cannot find it, it may not be legitimate.
CHECK YOUR CREDIT REPORT Review your credit reports periodically for unpaid medical bills that may be a result of fraud. In addition, it is a good idea to keep a journal of doctor visits and other medical services you receive to compare with any unexplained charges.
MAKE A REPORT If you think you have encountered fraud and you have double-checked for errors with your medical provider, you can report the incident directly to the inspector general at 1-800-HHS-TIPS (1-800-447-8477), or via e-mail at HHSTips@hhs.gov.
In addition, to get seniors involved, each state offers a Senior Medicare Patrol office as part of its State Health Insurance Counseling and Assistance Program. Workers at these offices will help you determine if you have been a victim of fraud and will forward your complaint to government investigators. To find the Senior Medicare Patrol in your state.
Be patient after you file a complaint, said Peter Budetti, deputy administrator and director of the center for program integrity at the federal Centers for Medicare and Medicaid Services. Sometimes seniors feel as if complaints have fallen on deaf ears, but the agency does its best to investigate all suspicious activity, Mr. Budetti said.
“Last year, calls to our 800 number triggered 30,000 investigations,” he added. “Just because we don’t call you back doesn’t mean your complaint isn’t being investigated.”
Ms. Schoen referred to a phone call four years ago from a
Vietnamese immigrant who had received a wheelchair she did not need and wanted to return. Further investigation found that 30 members of the woman’s senior community were also victims of fraud.
“It takes time,” Ms. Schoen acknowledged. But ultimately 13 providers were taken out of the system, and one went to prison. GET INFORMED For more information on preventing and reporting Medicare fraud, go to stopmedicarefraud.gov. Or check the fraud section of the “Medicare and You” handbook recently sent to all Medicare recipients.