The focus of Senior Medicare Patrol (S.M.P.) is to help people prevent, detect and report Medicare fraud and abuse, a multibillion dollar problem in America. Medicare fraud occurs when Medicare is billed for goods or services that have not been provided.
For example, a home health care business billing for a home visit it did not make or providing a patient with a walker but billing for a wheelchair.
Medicare abuse occurs when goods or services that are provided, but not needed, are billed. I have had numerous seniors tell me that they have had supplies, such as diabetes supplies, show up at their door unrequested and unneeded.
The first step is to prevent Medicare fraud and abuse by protecting your Medicare and Social Security numbers. Keep your Medicare and Social Security numbers safe and private as follows:
1. Only give your number to people such as health care providers who need it.
2. Never give your number out over the phone. Medicare does not call you.
3. If someone offers you a “free” service or supply and asks for your Medicare number, they have broken the law. There are a lot of legitimate health fairs in the Bluegrass that provide important information and services. Community Action Council sponsors several. However legitimate health fairs do not ask for your number when providing screenings.
4. Keep your cards in a safe place. It is best not to carry them with you unless you are going to use them.
The next step in preventing Medicare fraud and abuse is to detect it. Do this by carefully reviewing your Quarterly Medicare Summary Notice as soon as it comes.
1. Look for errors or charges that are not familiar. Most of us know that if you get an X-ray or have lab work done, there will be additional charges for the health care providers who perform and read these.
2. Look for things that are not familiar, especially for goods and services other than those provided by physicians or hospitals.
3. Keep a health care journal with your appointments, tests, supplies and medications written in it. Compare it to your quarterly Medicare Summary Notice.
Finally report any suspicious activity. There is a number to call on your Summary. You can also call the Community Action Council at 1-800-244-2275 and we will pass the information along. Please report. Some people have told me “I reported something, but the person who took the report did not seem interested.” They are interested, but they are taking hundreds of calls a day. In order for prosecutors to prove these cases, they must find a pattern, not just one instance. Your call may be one piece of an important puzzle that catches a criminal.