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Medicare Fraud

Every day people rip off Medicare. To help against Medicare fraud, we participate in the Illinois Senior Medicare Patrol project. Use this link to view more Senior Medicare Patrol information.

Protecting your personal information is the best way to fight against fraud and abuse. Everyday there are unscrupulous people who try to rip off the Medicare program. Medicare loses billions of dollars each year to errors, fraud, and abuse. You can make a difference by helping to identify and stop this wasteful spending!

Most people don’t realize how easy Medicare fraud is to recognize and stop. For example, Medicare does not give away free medical supplies or equipment. Claims that you can receive “free” medical supplies and equipment are often fraudulent.

In fact, Medicare does not pay the full amount for the purchase of medical care, supplies, and equipment. The difference between the costs and the amount paid by Medicare is paid by the Medicare beneficiary, or by his or her Medigap insurance or retirement heal plan.

You are generally the one in the best position to recognize when a bill for some sort of medical service appears to be wrong. You are also in the best position to apply what some people call the “smell test.” That is, if an offer doesn’t smell right, then it’s probably rotten.

Here is what you can do to help fight Medicare errors, fraud, and abuse.

  • Only carry your Medicare when you know you will need it.
  • Treat your Medicare and Social Security numbers like a credit card or bank account number. That is, never give them out to a stranger.
  • Remember that Medicare representatives do not call, visit, or to sell anything. Medicare never asks for a Medicare number, since they have it already.
  • Record doctor visits, tests, and procedures in a medical journal.
  • Save your Medicare Summary Notices until you no longer need them them shred them.

Here are some common steps you can take to detect errors, fraud, and abuse.

  • Always review your Medicare Summary Notices and compare them with your medical journal.
  • Look for charges any items or services you did not actually receive.
  • Look for items that are billed twice.
  • Look for services that were not ordered by your doctor.

Other types of fraud include billing for nursing care services when in-home workers are actually doing household chores, offering or accepting referral fees from another medical provider in exchange for a client referral, misrepresenting services on a claim form or service calendar in order to obtain payment not earned, charging patients for filling out Medicare claim forms, and billing for costs when already paid by the patient’s insurance company.

Here are some rules from Medicare to help protect you:

  • Approved plans will have a “Medicare-Approved” seal on their materials.
  • People who are selling Medicare drug plans can’t come to your home uninvited to sell or endorse any Medicare-related product, but they can call you about their plan.
  • Drug plans can’t enroll you into a drug plan over the telephone unless you call them, or unless you are adding prescription drug coverage to a Medicare Advantage Plan or other Medicare Health Plan you already have.
  • Drug plans can’t ask for payment over the telephone or Internet. The plan must send you a bill if you enroll over the telephone or Internet.

If you suspect errors, fraud, or abuse of Medicare, ask for an explanation from the medical provider. If this fails to satisfy you, contact the Senior Medicare Patrol hotline at 1.800.699.9043. This hotline was established for reporting errors, fraud, and abuse in the Medicare and Medicaid programs. It will ensure that your complaint gets into the right hands.

Before you call, collect as much information as possible, such as the medical provider’s name and any identifying numbers, the type of service or item billed, and date of the service. Be ready to provide a reason you believe Medicare should not have paid.

Use this link to read the entire quick facts on identifying Medicare fraud and identity theft.

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We serve Illinois' 13 southern most counties. Alexander, Franklin, Hardin, Gallatin, Jackson, Johnson, Massac, Perry, Pope, Pulaski, Saline, Union, and Williamson County.

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