INSURANCE

Laura Mutsko Agent, CSA and Certified Healthcare Reform Specialist

Q: Something does not look right on my Medicare Summary Notice. What should I do if I suspect someone is charging Medicare for medical services or equipment that I did not receive? A: What you are describing is Medicare fraud. While there are many different types of Medicare fraud, all have the same goal: to collect money from the Medicare program for care, services, treatment or equipment that was not provided. Medicare fraud results in higher health care costs and taxes for everyone.

Medicare and the Medicare Inspector General investigate cases of suspected fraud. While most cases of fraud are reported by workers within the health care field, many others are discovered by individuals like you who report inconsistencies between the care they received and their Medicare Summary Notice.

If you have questions concerning the amount billed to Medicare or if you think a charge is incorrect, your first step should be to call your provider if you are familiar with them. They may be able to give you a satisfactory explanation of the amount you are questioning. Your provider may also realize an error was made and take steps to correct it.

If you do not receive a satisfactory explanation or you are not familiar with the provider on the claim or you did not receive the services that were billed, you should call Medicare at 1-800-MEDICARE (1-800633-4227). When you call, be ready to report the details concerning the claim you are questioning including the provider’s name, any identifying number, the service or item provided and all other pertinent details. You will be asked for your name and Medicare number and why you think Medicare should not have paid for this service or item.

Everyone can help prevent Medicare fraud by following these tips:

1. Protect your Medicare number, Medicare card and Social Security number with the same care you would use for a credit card.

2. Be suspicious of any provider who tells you that the item or service is not usually covered but they know how to bill Medicare to get it paid.

3. Never let anyone use your Medicare card.

4. Do not share your information with anyone claiming to be from Medicare who calls you by phone or shows up at your door. Medicare and Medicaid do not send representatives to your home.

5. Do not accept gifts or offers of money in exchange for your Medicare number.

6. Keep records of all your appointments, tests, x-rays and other treatments, compare these to your Summary Notice and report suspected instances of fraud.

For questions concerning life, health, vision, dental, Medicare Advantage Plans, Medicare Supplements or other insurance, please call me at 440-255-5700 or email me at Lmutsko@mutskoinsurance.com.