Protecting Yourself Against Fraud, Waste, and Abuse

Fraud is generally defined as making a false claim in an effort to receive payment. For example, fraud in the healthcare industry can involve:

• Billing for medical services that weren’t ordered or provided
• Billing for durable medical equipment items that weren’t ordered or provided
• Providing services or items a person doesn’t need based on his or her medical history
• “Doctor shopping” – when a patient who may or may not have a legitimate physical ailment goes from doctor to doctor to obtain multiple prescriptions for narcotic painkillers

You are one of the first lines of defense against Medicare fraud - take action to protect your Medicare benefits!

Report services or items that you have been billed for but did not receive

• Refuse medical supplies you did not order
• Return unordered medical supplies that are shipped to your home
• Report companies that send you these items

Review your medical statements

• Make sure you receive the services or items billed
• Check the number of services billed
• Ensure that the same service has not been billed more than once

Protect your identity and benefits

• Never give out your Social Security, Medicare, health plan numbers, or banking information to someone you don’t know
• Carefully review your Plan Statement to ensure all the information is correct
• Know that free services DO NOT require you to give your plan or Medicare number to anyone

Be on the lookout for fraudulent schemes such as:

• People using your Medicare or health plan member number for reimbursements of services you never received
• People calling you to ask for your Medicare or health plan numbers
• People trying to bribe you to use a doctor you don’t know to get services you may not need