medicare fraud1 webMedicare fraud is a problem that costs taxpayers between $60 to $90 billion per year. Last year, as part of “Operation Double Helix”, law enforcement agencies charged 30 people with defrauding Medicare of $2 billion dollars by performing unnecessary genetic tests on saliva samples from beneficiaries. Although law enforcement is making strides in tracking down these criminals, for every scam they shut down, it seems a new scam rears its head. We know it pays to be informed and vigilant - so, is there a way for you to detect potential fraud? Yes! By reading your Medicare Summary Notice (MSN, or “This Is Not a Bill” statement) or Explanation of Benefits (EOB) from your Medicare Advantage plan.

Medicare fraud doesn’t just cost you and Medicare money – it can seriously affect your health. In fact, a recent study at Johns Hopkins University found that patients treated by providers (doctors, etc.) who were later banned from the Medicare program for fraud and abuse have worse health outcomes than those treated by non-excluded providers.

Medicare typically sends beneficiaries an MSN every three months. If you have a Medicare Advantage plan or a Part D prescription drug plan, you typically receive EOBs each month. Neither the MSN nor EOB is a bill.

However, that doesn’t mean these statements are not important! These documents are your first line of defense in detecting potential fraud because they contain important details about services you receive:

The name and address of the provider who performed the service.
The date on which the service was provided.
The name and code for the service that was provided.
The amount that you are responsible for.
For each of these pieces of information ask the following questions:
Is the name and address of the provider familiar to you? If NO, why not?
Did you receive services on the dates listed? If NO, why is it listed?
Are any services listed more than once? If YES, should they be?
If billed, does the amount match what the MSN or EOB states you are responsible for?

If the answers to any of these questions don’t make sense, ask your provider about the charges. For more information, or if you think you may be a victim of fraud, please contact the PA Senior Medicare Patrol (PA-SMP) at CARIE at 1-800-356-3606. All services are free and confidential.

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