Medicare fraud and abuse can happen anywhere and usually results in higher healthcare costs and taxes for everyone. Some examples include:

• A provider that bills Medicare for services or supplies they never gave you, like charging you for a visit you never had, or a back brace you never got.
• A provider that charges Medicare twice for a service or item that you only got once.
• A person who steals your Medicare Number or card and uses it to submit fraudulent claims in your name.
• A company that offers you a Medicare drug plan that Medicare hasn’t approved.
• If you think you’ve spotted fraud, you may want to call your provider’s office to ask about it. They may be able to help you understand the charges, or figure out if they made a billing error.

If you suspect Medicare is being charged for an item or service you didn’t get, or your Medicare card or number is stolen, call 1-800-MEDICARE 1-800-633-4227 to report suspected fraud or abuse.

When you call, have this information ready:

• Your name and Medicare Number.
• The name of the provider you’re reporting, along with any identifying information you may have.
• The service or item you’re questioning and when you supposedly got it.
• The amount that Medicare approved and paid.
• The date on your Medicare Summary Notice, health or drug plan’s Explanation of Benefits, or claim.

• Protecting yourself from medical identity theft 

Medical identity theft is a serious crime that happens when someone uses your personal information without your consent to commit Medicare fraud or other crimes. Use the following tips to protect yourself from becoming a victim.

Do:

• Protect your Medicare Number and your Social Security Number.
• Guard your Medicare card like it’s a credit card.
• Become familiar with how Medicare uses your personal information. If you join a Medicare health or drug plan, the plan will let you know how it will use your personal information.

• Remember that Medicare will never call you to sell you anything or visit you at your home. Medicare, or someone representing Medicare, will only call and ask for personal information in limited situations:
• A Medicare health or drug plan may call you if you’re already a member. The agent who helped you join can also call you.
• A customer service representative from 1-800-MEDICARE can call you if you’ve called and left a message or a representative said that someone would call you back.
• If you filed a report of suspected fraud, you may get a call from someone representing Medicare to follow up on your investigation.
• Contact the Federal Trade Commission if you think you’ve been a victim of personal identity theft.

Don’t:

• Give your Medicare card, Medicare Number, Social Security card, or Social Security Number to anyone except your doctor or people you know who should have it (like insurers acting on your behalf or people who work with Medicare, like your State Health Insurance Assistance Program (SHIP). Get the contact information for your local SHIP.
• Accept offers of money or gifts for free medical care.
• Allow anyone, except your doctor or other Medicare providers, to review your medical records or recommend services.
• Join a Medicare health or drug plan over the phone unless you call us.

The post Reporting Medicare fraud & abuse appeared first on C-Medisolutions.

You may be exposed to Medicare fraud at any time before you enroll in a plan when you access care at a doctor’s office or a facility, or at other times. Learn about common behaviors and actions below that may help you recognize and protect yourself from fraudulent activity.

Billing fraud

If you have Original Medicare, your doctor should not:

• Charge you for most preventive services
• Offer tests or other services that you do not need, especially if the doctor says that the more tests you receive, the cheaper they are
• Routinely waive your coinsurance (providers can waive cost-sharing for patients with great financial need, but not regularly)

Always confirm that you received the services listed on either your Medicare Summary Notice (MSN) or your Explanation of Benefits (EOB). Sometimes this can be hard to do if you receive services from several doctors at the same time. If you returned durable medical equipment (DME), your supplier should not continue to charge Medicare for rental fees or maintenance.

To report fraud, you should contact 1-800-MEDICARE (633-4227), the Senior Medicare Patrol (SMP) Resource Center (877-808-2468), or the Inspector General’s fraud hotline at 1-800-HHS-TIPS (447-8477). Medicare will not use your name while investigating if you do not want it to.

Marketing fraud

You are being misled if an agent from an insurance company says that you:

• Must sign up for a Medicare Advantage Plan to get Medicare drug coverage (you can also keep Original Medicare and enroll in a stand-alone Part D plan)
• Will pay a higher Part B premium unless you sign up for a certain plan (some plans help pay your Part B premiums or charge additional premiums, but your Part B premium will not increase based on your coverage choices)
• Must invite a plan representative to your home to get information about the plan or to enroll
• Can switch back to Original Medicare at any time if you are dissatisfied with the plan, without providing information about enrollment periods
• Will receive additional benefits that are actually Medicare-covered services
• Will receive additional benefits, such as dental or vision, that are actually covered by other insurance you have or are eligible for (such as Medicaid)
• Will lose your Medicaid benefits unless you sign up for a certain plan

Make sure to verify any marketing information you receive in the plan’s benefit manual or by calling the plan directly. Avoid enrolling in error by confirming whether the plan:

• Provides drug coverage
• Offers coverage through the coverage gap
• Has your providers, hospitals, and pharmacies in their network
• Offers additional benefits, such as vision or dental

Note: Insurance agents and brokers may receive a large fee for getting you to sign up for a Medicare private plan.

Never feel pressured to join any plan. Always make sure you understand what the plan is offering you, and how all your benefits are affected. Ask to receive information about the plan’s benefits in writing. If you suspect that an agent is not following the rules, save documented proof (such as the agent’s business card or marketing materials). Contact your State Insurance Department or State Attorney General Consumer Helpline to report your concerns.

If you find out that your plan has made fraudulent claims about your health or drug coverage, you may be eligible for a Special Enrollment Period (SEP) to disenroll from your plan and switch to another one.

The post Recognizing Medicare Fraud appeared first on C-Medisolutions.

It’s unlikely, but you should still be prepared

Medicare guarantees you certain rights. As long as you pay your premiums, you should be guaranteed the right to all of Medicare regardless of your age, your health, or where you live. Suppose you abide by Medicare deadlines (and pay your premiums). In that case, you should have access to Part D coverage, Medigap, and Medicare Advantage plans as well. However, there are some situations in which you may lose your coverage. Take care to avoid the following:

Failing to Pay Your Premium

Original Medicare is meant to be accessible. Many people are enrolled automatically and have their premiums automatically deducted from their Social Security payments. However, if for any reason you do stop paying your premiums, you will eventually lose your coverage. You’ll receive multiple notices that your bill is overdue. And finally, in about four months after your initial missed payment, Medicare will be able to drop your coverage.

When this happens, you also lose eligibility for Part D. You can re-enroll. Still, you’ll need to wait until general enrollment (January 1 to March 31) to sign up—and your coverage won’t begin until July. Plus, you’ll probably be stuck with higher premiums as a penalty for late enrollment.

Remember that missing any income-related monthly adjustment amounts you owe on Part B or Part D can also lead to loss of coverage.

Committing Medicare Fraud

Medicare fraud can take many forms, including misrepresenting other coverage you have, such as insurance through an employer. Or frauds like allowing someone else to use your Medicare card to access care. The simplest ways to avoid losing your coverage: Be honest, ask questions, and don’t let others use your card to obtain care.

“Disruptive Behavior”

Though Medicare doesn’t go into specifics, you can lose your MA coverage if you behave in a way that “substantially impairs” the plan’s ability to do its job—namely, providing services to you and/or other beneficiaries. While this possibility may sound scary, MA plans must follow specific steps before they can drop you for this reason. MA plans must also provide reasonable accommodations for beneficiaries with mental illness and developmental disabilities. So this particular clause can’t be used to discriminate based on cognitive conditions. Suppose your MA plan does attempt to disenroll you for disruptive behavior. In that case, it must also inform you of your rights to file a grievance. If your MA plan does ultimately drop you, you’ll be put back onto Original Medicare.

What Happens If Your Plan Closes Up?

If your insurance company goes bankrupt or decides to stop dealing with Medicare, you’ll lose that plan’s coverage. However, you’ll receive notice from your company or from Medicare beforehand. You’ll be entitled to a special enrollment period during which you can select a new plan that will kick in when your old plan ends. Your Medicare Advantage, Part D, and Medigap coverage get the same protection.

The post WHAT TO DO IF A PLAN DROPS YOU appeared first on C-Medisolutions.