Legal Guide

4 Ways to Protect Yourself from Medicare Fraud

Medicare fraud can come in many forms so it often goes under the radar until damage has already been done. So to help you spot Medicare fraud before it is too late, we have created this guide to help you identify what Medicare frauds are and ways on how you can protect yourself.

Knowing and Understanding Medicare Fraud

It goes without saying that you cannot identify fraud if you do not know what they are. For all you know, your medical service provider might already be committing fraud without your knowledge.

To fill in this information gap, we have listed some of the most common types of fraud that are often easy to spot once you really start looking.

Upcoding

It is when your medical provider uses an incorrect billing code for more charges. For example, a doctor provided a simple brief medical service. Rather than coding it as it is, it was coded otherwise as an extensive and complicated medical procedure.

Phantom Charges

It is when medical service providers bill for a service or procedure that was never truly render

Misrepresentation

This fraudulent practice can come in many forms such as misrepresentation of locations of service, dates, or even providers of service. It might seem far-fetched, but there are service providers who hire untrained, unlicensed, and unqualified medical staff.

Off-label promotion of Pharmaceuticals

It is when your service provider prescribes or promotes a pharmaceutical drug that is not recommended or has been approved for other use by the FDA.

Keep in mind that apart from fraud done by medical providers, there are also some cases of identity theft related to Medicare fraud. Even people not from the healthcare industry might take advantage of these government benefits and use your name while doing so.

Check your reports and receipts regularly

The best way to detect Medicare fraud is to always be on the lookout for crooks and abusers.

Every time you receive the statements from Medicare, make it a habit to cross check whether all the dates and details are correct or not. This way, you can immediately report if there are any inconsistencies and have them corrected as soon as possible.

As for the receipts and statements you get directly from your medical service provider, always check if there is any inconsistency in the service you just received from the service you have been billed. In cases like these, it would be best to call your medical service provider first because it might just be a billing error or miscommunication from their end.

Keep in mind that medical service providers can make mistakes and unintentionally make some errors in your billing statement.

Be wary when dealing with private companies

Protect yourself from fraud and always be wary when dealing with private companies that offer Medicare plans. Even the official website of Medicare acknowledges this problem in the system and has listed a few ways on how you can protect and free yourself from these crooks and abusers.

We have listed some of the red flags that you should look out for when dealing with fraudulent private companies

  • Get your private details like your Social Security number or bank accounts over the phone.
  • Door-to-door sales or promotion of any Medicare-related products
  • Suggest a specific and particular plan you do not even need
  • Voluntary enrolls you in a drug plan over the phone
  • Offer incentives (like cash or free meals) just for you to sign up
  • Too-good-to-be-true plans and offerings
  • Unrealistic and inappropriate salesy pitches like “the best” or “highest rank” company
  • Tries to convince you to sign-up for non-health-related products on top of your Medicare health or drug plan
  • Unlicensed and uncertified independent agents or brokers
  • Make a sales pitch about an unapproved Medicare plan
  • Use false information to convince you to sign up

Report and stop fraud sooner

Once you know that you detected any inconsistencies or see any of the red flags above, then it is best to contact a healthcare fraud attorney or report it to the MEDICARE hotline and your State Health Insurance Assistance Program (SHIP) as soon as you can.

You would not be only protecting yourself from Medicare fraud, but you would also be doing a great public service by preventing these crooks from abusing and pressuring our healthcare system.


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