Have you ever been trying on a piece of clothing in a department store dressing room and spotted a sign warning shoppers about the consequences of stealing? Shoplifting is a fairly high profile crime costing both businesses and taxpayers increasingly large amounts of money annually. The inevitable outcomes include increases in the price of goods, fines, humility and possible jail time for the offender. The consequences are much the same for Medicare fraud, only on a larger scale and with a much greater cost. Here, we will discuss the elements of Medicare fraud and abuse, prevention and the inherent damage it causes.
To begin, let’s define what Medicare fraud and abuse actually entails. Fraud is an intentional falsification or deception of information involving Medicare. Abuse is the improper use of Medicare services. For example if a medical practitioner initiates services not medically necessary or causes Medicare costs that are unwarranted that is abuse of the system. A complaint about the care being received is not considered abuse, however if the doctor or hospital bills Medicare for a procedure you did not receive, then the doctor or hospital is guilty of fraud. Using another person’s Medicare information or card to obtain medical care or equipment is fraud. If medical equipment was used in the home and later returned, but the individual continues to bill Medicare for rental of the equipment, that is fraud.
An emerging method of Medicare fraud is through false medical insurance companies who offer their clients overly-reasonable drug plans that are not approved by Medicare. Legitimate Medicare approved drug plans are available through reputable Medicare supplement firms and are happy to provide proof of the plan’s legitimacy. Another form of Medicare fraud is the use of false information to entice clients to join a particular Medicare plan. With so much information floating around the media and the internet about recent Medicare changes, it is sometime hard to see the truth. Many reputable Medicare supplement plans are available, however if you need confirmation of their authenticity simply contact Medicare via their website or 1-800-medicare.
There are several things each individual can do to prevent Medicare fraud. To begin with, never allow anyone to know your Medicare number except your doctor or Medicare provider. Treat your Medicare number with as much security as you would with the PIN number for your personal bank account. If a disreputable person gets a hold of your Medicare number it could lead to identity theft. The same is true with your medical records. Only doctors need to know your medical history and recommended services. Also, don’t put your doctor in a position where he/she will have to make a choice between Medicare abuse and losing a patient. For example, do not request unnecessary services or procedures from your medical practitioner. Likewise, do not ask them to make false statements about your medications or equipment for the purpose of obtaining money from Medicare.
The next set of precautions for preventing Medicare fraud or abuse is based on avoiding scam artists. Let’s face it, the days of door-to-door salespeople are gone, and there is good reason for that. Too many people were being taken advantage of or being outright robbed. Therefore, never ever accept medical supplies or medications from a door-to-door salesperson no matter how legitimate they may seem. Also, it would be wise to be very careful when accepting Medicare services that are being offered as ‘free’. In all probability the cost of the service is rolled into another area of payment. Use of the service will probably not do any harm, just be aware that you will be paying for it somewhere else.
If a medical practitioner or supplier offers items or services that are not usually covered by Medicare but claim to have the ability to bill the expenses elsewhere, do not accept their services. Billing for services or items in ways other than their proper designation is Medicare fraud, and you do not want to be a part of it. It is also a very good idea to review your Medicare Summary Notice on a regular basis. Keep track of appointments, hospital admission and discharge dates, tests, x-rays, and procedures on a calendar. Then compare the calendar to your Medicare Summary Notice. If you happen to notice any discrepancies, phone Medicare.
According to the Washington Post, Medicare fraud and abuse costs American taxpayers approximately $60 billion each year. Therefore it behooves each and every person received legitimate Medicare to safeguard their own information and prevent any fraud or abuse from taking place in their own personal medical circle. If each person had the ability to carry out this amount of prevention, fraud would simply fade away. Unfortunately there are persons in our world whose single purpose in life is to swindle the government for their own gain. Do your small part, protect yourself and your information because Medicare fraud hurts everyone one of us.
