Help Stop Medicare Fraud

Overview

Medical identity theft and Medicare fraud and abuse are serious issues, costing all of us over $60 billion every year. You can help others spot fraud, theft and errors by reviewing the Summary Notices your loved ones receive from Medicare. By knowing what “red flags” to look for on Medicare Summary Notices (MSN), you can help your loved ones know how to spot potential fraud, abuse or medical ID theft. This guide will help you spot those flags – and will tell you what to do when you see them.

Great Reasons to Do This Project

Participating in this project can help stop health care fraud, medical identity theft and help loved ones keep track of their health expenses.

Step 1: Review the Medicare Summary Notice (MSN)

Every quarter, Medicare sends enrollees a Medicare Summary Notice (MSN) summarizing claims for health care services that Medicare processed for that enrollee during the previous three months. The MSN includes details on health services received, how much Medicare paid on behalf of the enrollee and any additional amount the doctor or other health care providers are allowed to bill.

Medicare Summary Notices are not the easiest documents to understand. AARP has a “decoder” that explains each entry, code, figure, and column so you know what it means and what you should do if you spot something that doesn’t look right. Check out the Part A and Part B explanations at www.aarp.org/healthtools (under Medicare Summary Notice Decoders). You’ll also find helpful the Tip Sheet in this guide for “What to Look for in an MSN.”

You don’t have to wait for the mailed statement. MSNs are also online at www.myMedicare.gov. It is easy to help someone set up an account for any time access to claim information. Just follow the instructions. New claims information is typically reported within 24 hours of processing.

Step 2: Recognize Errors or Possible Fraud

Now it’s time to check your loved one’s calendar to make sure he or she saw the doctor on the dates listed on the MSN. Ask for any statements, bills, or other papers he or she got when leaving the doctor’s office. Check to make sure the dates, services and billing codes match. If they don’t have any paperwork, help them contact the doctor to ask for a statement that includes the billing codes. If they didn’t see that doctor, didn’t receive the specified medical service or equipment, or didn’t get the listed treatment in a hospital, clinic or other facility, they may be the victim of identity theft or fraud.

Your friend or loved one will need to be comfortable sharing personal information about his or her health with you. Determine if you are the right person to help here. Also, you should not copy, keep, or share with others any of medical information you learn. Important laws are in place to protect everyone’s right to privacy about their medical issues and they need to agree to the release of their medical information to others.

If the discrepancy doesn’t appear to be a mistake, it’s not up to you to determine if it is or isn’t fraud. Just take the next step.

Step 3: Investigate Discrepancies

To resolve discrepancies between the MSN and your loved one’s records, start by helping them contact the doctor, hospital or other health care provider who filed the claim. It could be a simple mistake or a clerical error. If this is the case, the provider who filed the claim with the mistake should report the error to Medicare. The correction will appear on a later statement. You could also follow up by checking your friend’s account at www.myMedicare.gov.

If the discrepancy doesn’t appear to be a mistake, it’s not up to you to determine if it is or isn’t fraud. Just take the next step.

Step 4: Report to Authorities

Call Medicare at 1-800-MEDICARE (1-800-633-4227). In fact, any time you have questions about something that doesn’t seem right about an MSN and which the doctor doesn’t resolve, call Medicare. If you’d rather write a letter on your friend’s behalf, send it and a copy of the MSN to the address in the box on the front of the MSN, explaining what you think is wrong.

You can also call your local Senior Medicare Patrol (SMP). SMP volunteers can answer your questions, help work out solutions to problems, or assist you in filing your report. You can find the SMP in your area at www.smpresource.org.

If you speak to someone at either office, ask for clear instructions on:

• When you or your loved one can expect to hear back
• What to do if you don’t hear back

Senior Medicare Patrol (SMP) volunteers can answer your questions, help work out solutions to problems, or assist you in filing your report.

If it appears that your friend or loved one's Medicare number may have been stolen, ask: 

• Whether he or she should continue to use the current Medicare number for health care services. If not, ask how he or she should obtain or pay for services while the investigation is ongoing.
• Whether you or your loved one should contact any of his or her healthcare providers regarding the suspected fraud or theft.

Step 5: Commit to Follow Up

Make a note on your calendar and your loved one's calendar reminding you both of the follow-up date promised by Medicare (or the date you were told to check back). This will help ensure the issue ultimately gets resolved.

Step 6: Inspire Others on CreateTheGood

KEEP UP THE GOOD!

Visit Create the Good for a range of opportunities to use your life experience, skills, and passions to benefit your community.

Important Resources

Here are some additional resources you can share with those you are helping. You can also download and print this list from the ‘Supplemental Materials and Information’ section below.

Where to Report Frauds and Scams

• Medicare - 1-800-MEDICARE (1-800-633-4227)
• Your insurance company’s Fraud Division - Phone number on insurance statement
• Your Medicare Part D plan administrator - Phone number on drug plan statement
• State Attorney General - www.naag.org for contact information
• State Insurance Department - www.naic.org for contact information
• SMP (Senior Medicare Patrol) - 1-877-808-2468 or www.smpresource.org
• Identity Theft Hotline - 1-877-ID-THEFT (1-877-438-4338) or www.ftc.gov/idtheft

Where to Get More Information

• AARP - For more information about health care fraud, to use the interactive guide to MSNs and more, check out www.aarp.org/fightfraud.
  • Want more information about Medicare? Check out www.aarp.org/medicare for articles and updates.
  • Order Understanding Medicare, What You Need to Know (D19327) by sending an email with your name and address to fulfillment@aarp.org.
• Medicare - www.MyMedicare.gov
  • Check out the information at www.medicare.gov and get a copy of Medicare and You, Medicare’s basic guide to Medicare
• Coalition Against Insurance Fraud - www.insurancefraud.org
• SMP (Senior Medicare Patrol) - 1-877-808-2468 or www.smpresource.org

Supplemental Materials

Tip Sheet: What to Look for in an MSN
Use this tip sheet to review the parts of the Medicare Summary Notice (MSN) with your friend or loved one.

Tip Sheet: Medical Identity Theft
Learn about medical identity theft, how to prevent it and what to do if you think you have been targeted.