Prevent, notice and report Medicare fraud
Medicare fraud costs about $60 billion a year, raising the cost of health care for everyone and making it harder to get the care you need. Check out these quick tips and be on alert for Medicare fraud, errors and abuse.
Protect yourself during Open Enrollment
Medicare Open Enrollment is a prime opportunity for fraud to happen, when Medicare options are heavily marketed.
Common examples of Medicare fraud
- Scam calls saying Medicare is offering new cards.
- Billing for services or equipment never ordered or received.
- Double billing or upcoding.
- Medicare identity theft and unauthorized use of Medicare numbers.
- Employing pressure or enticement tactics to sell Medicare plans.
- Fake Medicare plan enrollment ads disguised as insurance companies that require you to enter all your personal information to get plan information.
- Suggesting a plan is preferred or endorsed by Medicare – Medicare does not endorse plans.
- Offering cash or gifts to enroll in a specific plan.
- Charging for Medicare enrollment.
- Receiving a “refund” for overpayment of benefits.
How to protect your information
- Don’t answer calls from unknown numbers.
- If a caller claims to be from Medicare, hang up.
- Report suspicious claims, like for unwanted braces, to Medicare by phone at 800-633-4227 or report fraud online to the Senior Medicare Patrol.
- Never give out your ID information to someone who calls without you requesting the call first.
- Offers of refund, cash or gift offers are a ploy to get your personal and financial information.
- Check Medicare, health, and other insurance statements for billing concerns or suspicious claims.
- Do not click on ad links. These are often links to steal your information.
- Medicare and Medicaid do not endorse any plans and do not offer “preferred” plans.
- Insurance companies, agents, and brokers cannot offer gifts or enticements to enroll in plans.
- Plan representatives cannot use pressure or scare tactics to make you enroll in plans.
How SHIBA can help you
Fraud can happen at any time. It includes criminals stealing directly from Medicare or doctors, pharmacies or medical suppliers providing care or equipment you don’t need.
SHIBA volunteers and Washington SMP can provide everyone involved in your care with the information and tools to find and prevent fraud before it happens. If you suspect fraud has already happened, our volunteers will help answer your questions and report your concerns to investigators.
You can call SHIBA at 800-562-6900 or report suspected fraud online.
How to identify Medicare fraud
You can take several steps to help prevent and identify fraud:
- Keep copies of all your receipts and bills.
- Learn about your Medicare Summary Notice (MSN) or Explanation of Benefits (EOB) and how to understand the summary of your care.
- Check your MSN or EOB regularly to make sure you received all the care it lists.
- Treat your Medicare card like a credit card.
- Don’t let anyone borrow or pay to use your Medicare number.
- Don’t give out personal information such as your Medicare number, Social Security number, bank account or credit card numbers to anyone unless you contacted the person or organization.
Medicare will never contact you to ask for personal information.
Scams and fraud are always changing. Learn about the latest fraud trends and most common types of fraud by visiting the national Senior Medicare Patrol Resource Center.
Scam calls
Even if you signed up for the “do not call list,” you may still get frequent scam calls. If so, visit the Federal Trade Commission (FTC) page about phone, email and text scams. The FTC also provides information on protecting yourself from financial crimes and consumer fraud.
Social Security fraud
If someone stole your Social Security number or used it without permission, you can report fraud to the Social Security Administration. Social Security also provides information about benefits and preventing identity theft.
Washington State Medicaid/Apple Health fraud
Washington Health Care Authority is our state’s organization that oversees Medicaid, behavioral health, and public employee benefits. If you have Medicaid and suspect someone has fraudulently used services or supplies, you can report fraud by calling 1-833-794-2345 or emailing hottips@hca.wa.gov.
Visit the Health Care Authority website to learn more about their programs and how to prevent fraud.
Billing errors or complaints
First, contact your plan or provider to resolve the issue. If this doesn't help, submit your complaint online.