Detection Tips
Be suspicious if the provider tells you that:
- They know how to get Medicare to pay for an item or service.
- The more tests they provide, the cheaper they are.
- Medicare wants you to have the item or service.
- Equipment, like wheelchairs or seat lifts, is free.
Be suspicious of providers who:
- Do not charge copayments or coinsurance without first checking on your ability
to pay.
- Advertise free consultations to people with Medicare.
- Claim they represent Medicare or a branch of the Federal Government.
- Use pressure or scare tactics to sell you high-priced medical services or
diagnostic tests.
- Bill Medicare or another insurer for services or items you did not get.
- Bill Medicare for services or equipment that are different from what you
received.
- Bill Medicare for home medical equipment after you returned it.
- Use telemarketing and door-to-door selling as marketing tools.
- Use another person's Medicare card to get medical care, supplies, or equipment
for you.
- Offer non-medical transportation or housekeeping as Medicare-approved services.
- Put the wrong diagnosis on the claim so Medicare will pay.
- Bill home health services for patients who are not confined to their home or for
Medicare patients who still drive a car.
- Ask you to contact your doctor and ask for a service or supplies that you do not
need.
- Charge copayments on clinical lab tests and on Medicare-covered preventive
services such as PAP smears, PSA tests, or flu and pneumonia shots.
- Offer you payment or gifts to go to clinics or offices.
Equipment Fraud
Be aware of suppliers who:
- Offer a free power wheelchair, scooter, or other equipment.
- Want you to use their doctors.
- Offer to waive Part B coinsurance or deductible.
- Recommend a motorized wheelchair when you requested a scooter.
- Call you when you did not give them your phone number.
- Complete a certificate of medical necessity (CMN) instead of the doctor.
- Alter a certificate of medical necessity (CMN) or prescription.
- Alter claims to receive higher payment.
- Charge a restocking fee or a pickup fee for equipment/supplies that you are
returning.
Your doctor is the best person to know what your equipment needs are.
Prevention Tips
To help protect yourself and Medicare, you should report all suspected instances
of fraud and identity theft.
The following is a list of tips to prevent fraud:
- Never give your Medicare number to anyone, except your doctor
or other Medicare provider.
- Don’t allow anyone, except your medical providers, to review
your medical records or recommended services.
- Don’t contact your doctor to request a service that you do not
need.
- Don’t ask your doctor to make false entries on prescriptions,
bills, or records in order to get Medicare to pay.
- Don’t accept medical supplies from a door-to-door salesman.
- Do be careful in accepting Medicare services that are
represented as being free.
- Do be cautious when you are offered free testing or screening
in exchange for your Medicare card number.
- Do be cautious of any provider who states he or she has been
endorsed by the Federal Government or by Medicare.
- Do avoid a provider of healthcare items or services who tells
you that the item or service is not usually covered, but they know how to bill
Medicare to get it paid.
- Do use a calendar to track your appointments, admission and
discharge dates, and what tests or X-rays you get, and compare this with the
Medicare Summary Notice (MSN) you receive.
For more information on protecting yourself from fraud, please visit the
Stop Medicare Fraud website