November, 2009

Medicare receives 4.4 million claims a day and approximately 1 out of 10 of those are fraudulent. All of the fraudulent claims add up to a large sum of wasted time and money and the government is trying to put a stop to it. The Department of Justice (DOJ) and the Health and Human Services (HHS) Office of the Inspector General have been working together to reduce fraudulent activity.

In 2008, the DOJ and HHS and the Centers for Medicare and Medicaid Services worked together through the criminal and civil systems to secure 588 criminal convictions, obtain 337 civil administrative actions against individuals and organizations who were committing Medicare Fraud, and recovered more than a billion dollars in health care fraud monies . . . To date in fiscal year 2009, the Department of Justice has already recovered nearly a billion dollars in health care fraud monies and recorded 300 convictions.

In addition to catching Medicare thieves the DOJ and HHS want to enable seniors to participate in the fight. They want to raise awareness about the kinds of fraud that are happening and give seniors the tools they need to deter, detect and defend!

Medicare Fraud Examples

Here are a few examples of how Medicare is scammed out of billions of dollars a year.

• Medicare is billed for services or equipment not received
• An unathorized person uses a Medicare card to receive treatment, supplies or equipment
• Medicare is billed for equipment after it has been returned
• A company offers an unapproved Medicare drug plan
• A company leads you to join a Medicare plan using false information

Deter

Medicare recipients need to keep themselves safe.

• Treat your Medicare number and Social Security number like gold. Avoid carrying them in your wallet or purse.
• Your Medicare number is not needed to get free equipment. If someone offers you free equipment and then asks for your Medicare number, run away or hang up the phone.
• Your number is for your use only. It is illegal for others to file claims with your Medicare number.

Detect

Learn to recognize common schemes. A few common fraud schemes are:

• Being approached in grocery stores, parking lots, on the street, etc. and being offered goods, services or help in exchange for your Medicare number. Just run away!
• Receiving a call from a  phone solicitor doing a health survey and asking for your Medicare number. Just hang up! They don't need your number to conduct a survey.
• Receiving a call from a telemarketer claiming to be with Medicare or Social Security asking for you to pay for equipment over the phone or the internet. Again, hang up!

Defend

It's critical that Medicare recipients check their statement summary sheets and look for:

• Were you charged for the same thing more than once?
• Are there doctor visit dates look unfamiliar?
• Were you over charged for a service?
• Were you charged for equipment or services that you didn't receive?

If you see any of these problems make a phone call to your provider or Medicare to get it resolved. It could just be a clerical error or it could be a fraudulent act that needs to be reported.

Help is Available

To some the task above may seem very overwhelming. The DOJ and HHS understand that seniors want to protect themselves but may not have the knowledge to do so. For this reason Senior Medicare Patrols (SMP's) were created. SMP's are groups or seniors, formed in communities, that help other senior citizens learn how to combat Medicare Fraud. They bring awareness to seniors in the community, teach seniors how to read and understand their Medicare summary statements and offer support.

• Use the www.smpresource.org web site to find a group in your area.

Medical identity theft and Medicare fraud are a huge problem that the government cannot tackle on its own. While they do their part it's important for senior citizens to do their part to protect themselves from medical identity theft and be on the watch for Medicare fraud.

Fight Back! Brochure

More detailed information is available in the Fight Back! Medical Identity Theft and Medicare Fraud brochure put out by the HHS.

HHS Even Webcast on Preventing Medial Identity Theft and Medicare Fraud

Video Points of Interest

• Time 7:11 Assistant Attorney General of Civil Division of DOJ, Tony West, discusses the consequences of Medicare fraud and the work of the DOJ and HHS partnership.
• Time 14:38 Inspector General, Dan Levinson, discusses new fraud education materials.
• Time 23:08 SMP volunteer, Joanne, discusses her experiences with Medicare fraud and her roll as part of the SMP in her community.

More information is available at Stop Medicare Fraud's website.