Frauds and Scams

The SMP is a national program to educate Medicare beneficiaries about Medicare fraud, errors, and abuse. Medicare loses an estimated $60 billion each year due to fraud, errors, and abuse, though that number is sometimes impossible to measure. Every day, issues related to these problems affect people across the country, often costing them time, money, and well-being.
Medicare-related errors contribute to this annual loss even though errors can be honest health care billing mistakes. However, repeated errors by a doctor or provider could be considered a red flag of potential fraud or abuse if not corrected.
Some common examples of fraud, errors, or abuse could include:
• Charging for services or supplies that were not provided
• Misrepresenting a diagnosis, a person’s identity, the service provided, or other facts to justify payment
• Prescribing or providing excessive or unnecessary tests and services
How to stop Medicare fraud?
If you are a Medicare beneficiary, start by learning how to read your Medicare statements! Read your Medicare Summary Notice (MSN) or Explanation of Benefits (EOB) in the paper form that is mailed to you, or go online to Medicare.gov and review claims digitally.
Caregivers, help by educating yourself and your clients or loved ones on how to prevent and detect health care fraud, errors, and abuse. Be on the lookout for things like boxes of knee braces (known as durable medical equipment, or DME) lying around the house. This is a common scam and may mean your client or loved one has been a victim. Remind your clients or loved ones to never give out their Medicare number or other personal information over the phone.
Families, help by talking to your loved ones about protecting their Medicare number just as they would a credit card number. Encourage them to check their Medicare statements for fraud, errors, or abuse and never give out their Medicare number over the phone for any reason. Help your loved ones create a Medicare.gov account to access their Medicare claims online or remind them to open and review their statements when they come in the mail every three months.
Partners and professionals, help by sharing SMP information on social media, referring clients and consumers to the SMP, and inviting the SMP to speak during a shared event. Identify ways to collaborate on mission-related topics and information.
Health care providers, help by talking to patients about health care-related scams such as those related to durable medical equipment, genetic testing, or new, plastic, or chipped Medicare cards. Reassure them that your office and their other doctors’ offices are not going to call to offer them services or equipment.
Lastly, as a community, help by looking out for your older neighbors. If you overhear someone talking about Medicare, don’t be afraid to give information about the local SMP and SHIP. Encourage those you know to talk to a trusted source about their Medicare questions and tell your neighbors about the most recent Medicare scams. Consider volunteering with your local SMP!
For more information, go to: https://smpresource.org/medicare-fraud-prevention-week-week
Teaching Suggestions:
• Ask students to make a list of the common examples of Medicare fraud or abuse.
• What are some actions all of us can take to stop Medicare fraud?
Discussion Questions:

1. What is the Senior Medicare Patrol? How does it help in preventing Medicare fraud?
2. How can Medicare beneficiaries, caretakers, families, partners, and professionals, healthcare providers, and the community help in preventing Medicare fraud?