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How To Determine Medicare Fraud

If you’re living in the US, Medicare can be a godsend for all of your medical needs. Medicare is a federal health insurance program designed to cover people who are at least 65 years old, young people with disabilities, and those who have end-stage renal disease.

Having Medicare means enjoying hospital and medical insurance and prescription drug coverage. With the benefits you can enjoy with Medicare, the quality of your life can drastically improve – or so you thought.

Today, Medicare fraud is becoming more common since schemes are getting more advanced. Thus, you can become a victim without you noticing it. Medicare fraud and abuse usually happen when a claimant isn’t entitled to his or her health care reimbursement. Instead of enjoying free medical or hospitalization benefits, you’ll end up paying for expensive bills. And sometimes, you’ll receive bills for a treatment that you don’t need.

Medicare Frauds

Medicare fraud can come in different forms, but one thing is certain: it aims to collect money from the Medicare program in an illegal way. This is a clear deprivation of your rights as a US citizen. Some of the most common Medicare frauds happen when:

1. You have a billing error.

It’s important to keep in mind first that having a billing error doesn’t immediately mean that you’re scammed with your Medicare privileges. Medical providers and organizations involved in your claims are also human beings, so committing errors will always be a possibility.

If you want to be sure that these errors aren’t associated with Medicare fraud, take the time to contact your service provider and your Medicare provider once you receive a notification for a billing error. Inquire why the billing error occurred and get as much as information as you can to get a better view of the situation.

While you’re at it, make sure that all the parties involved come up with a resolution on how to avoid or minimize billing errors moving forward. Negotiating a single billing error can be stressful and time-consuming, especially if you have a lot of things on your plate.

2. You’re asked to pay for a bill over the phone.

Because of the advent of technology, everyday chores can be done without leaving the comforts of your home. And although it can be very convenient to pay your medical bills over the phone, you should never do it. This is one of the most obvious signs of Medicare fraud.

Most scammers will call you, and pressure you into paying your bills over the phone. Usually, they will even threaten to drop or cut your coverage if you don’t pay for it. They’ll tell you that payment for your bills are urgent, and can result in penalties and fees if you don’t act immediately.

If you suspect issues with your bills, it’s important to call your Medicare provider.

Always validate the information you received through a call. This should be your first step before doing anything with your Medicare coverage.

3. You’re asked to share your personal information over the phone.

As mentioned, technology has made everyone’s lives easier because it allows you to do a lot of things at the same time. But no matter how busy you are, you should be cautious the moment you receive a phone call from a person who’s asking for your personal information. Your Medicare provider will not require you to give your medical history and bank account number in order to “update your information on their accounts.” This is usually one of the most common schemes used by scammers for Medicare fraud.

Scammers aren’t really interested in knowing you, what you do, or your medical history. They’re only after your personal information so they can freely commit identity theft and/or Medicare fraud.

4. Your Medicare ID was tampered.

Your Medicare ID is your ticket to utilize the benefits you have under the insurance. Usually, you just have to present your Medicare ID to medical providers and hospitals to enjoy their services for free. These are just some of the reasons why you should always secure your Medicare card.

Be wary when an individual or organization asks for a certain amount in exchange for your Medicare ID. Replacements of old Medicare IDs are processed for free. If someone asks you to pay for whatever service just to have your Medicare card, you might be dealing with a scammer.

5. You’re pressured or forced by medical providers to undergo a service that you don’t medically need.

There are a lot of medical treatments and procedures available today. More often than not, life-threatening diseases, such as heart failure, can now be treated by different innovations from the healthcare industry.

However, there will be instances when medical providers pressure or force their patients to undergo a service which isn’t necessary at all. Medical providers are doing this in order to hike up your bill. And while Medicare covers most of your medical and hospitalization bills, undergoing a service that you don’t need can oblige you to shell out a certain amount of money from your pocket. If you’re not financially prepared, these services can become the reason why you’d have to take out loans.

If you see yourself involved in this kind of situation, get a second opinion from another medical provider. Second opinions are usually covered by Medicare, so make the most out of this service. Although time-consuming and stressful, getting a second opinion will be worth it as it can save you from being scammed and paying for services that you don’t actually need.

How Can You Avoid Medicare Fraud?

If you think you’re a victim of Medicare Fraud, immediately report your case to the authorities. Call your medical and Medicare provider as soon as possible. Don’t wait for another sign to come up because when it actually does, you’re usually in the worst case scenario. Remember, Medicare exists in order to make your life easier and healthier, not become the reason for you to be covered in debt.

Medicare can make your life a breeze in more ways than one. Aside from having access to medical funds the moment you need it, Medicare also allows you to live a stress-free life and have a more positive outlook for the future. To ensure that you can experience all of these things with Medicare, avoid Medicare fraud by following these tips:

1. Always protect your Medicare number.

For sure, you won’t let anybody have access to your credit card or give out credit card information to others unless necessary. You understand that your credit card plays a vital role in your financial stability.

If you want to avoid any type of Medicare fraud, treat your Medicare number the same way you treat your credit cards. Only give your Medicare number to reputable doctors and trusted healthcare providers.

It’s also important to watch out for individuals or organizations who offer “free” services in exchange for your Medicare number.

2. Always protect your medical information.

If you have been suffering from a certain illness or disease, having someone recommend you to undergo a specific medical procedure can be very inviting. You might think that this recommendation is finally the solution to all of your medical-related problems. However, when the person giving the recommendation isn’t your doctor, learn how to decline. Your medical information should only be accessible to your doctors, and you should only undergo medical treatments appropriate to your case.

3. Educate yourself with Medicare’s coverage rules.

The knowledge you have about Medicare’s coverage rules can be a powerful tool for you to avoid any type of fraud. When you know what you’re entitled to, you can easily identify if any of these entitlements are compromised or deprived of you. You can also assess how shady it is once a medical provider tells you that there are ways on how you can cover a service that isn’t normally covered by the insurance. The more information you have about Medicare’s coverage rules, the easier it’ll be for you to determine if you’re already becoming a victim to a Medicare fraud.

4. Be skeptical.

Spotting a Medicare fraud can be easy if you trust your guts. If you think a medical provider forces or pressures you to undergo a treatment that you think you don’t need, ask a second opinion from another specialist. Learn to determine when a recommendation for Swedish massages and dance classes are no longer necessary for your medical case. If possible, ask for recommendations from your friends and family, as well. If they have been using the insurance for years or decades, surely they can provide you with the dos and don'ts to avoid Medicare fraud.

Pay Attention

Contrary to popular belief, identifying Medicare fraud is actually fast and easy. Once you know what signs to look for, you can immediately determine if you’re already a victim of a particular scam.

Let this article become your guide so you can make the most out of your Medicare coverage and enjoy the benefits which are rightfully yours!

This article does not necessarily reflect the opinions of the editors or management of EconoTimes.

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