Author: Mike Causey, Insurance Commissioner
It’s a $60 billion problem. That’s how much money is lost to billing discrepancies, fraud, abuse and waste in the Medicare program.
Medicare fraud wastes taxpayer dollars and robs Medicare beneficiaries of the care they deserve. It occurs when a person or company knowingly deceives Medicare. They do this intentionally to receive elevated payments from the program.
Medicare abuse occurs when providers seek Medicare payment they don’t deserve but they have not knowingly or intentionally done so. Abuse can also involve billing for unsound medical practices.
North Carolina’s Senior Medicare Patrol (SMP), which is located within the Department of Insurance, can help. SMP can provide you with information you need to protect yourself from Medicare errors, fraud and abuse; detect potential errors and report your concerns to appropriate officials.
We use trained certified counselors to help inform and empower seniors in the fight against healthcare fraud. We can help with questions, concerns or complaints about potential fraud and abuse issues.
Here are some examples of fraud and abuse:
- Billing for services, supplies or equipment that were not provided.
- Calling Medicare beneficiaries and asking for their Medicare account number, saying it is needed to get a new Medicare card or keep their Medicare benefits.
- Trying to get a Medicare number in exchange for “free” services.
- Billing for services different than what was provided to get a higher payment.
- Billing for medically unnecessary services or supplies.
- Billing for excessive medical services or supplies.
Medicare fraud and abuse affects everyone by wasting billions of taxpayer dollars. This also affects you. False information can end up on your medical records, leading to improper medical care later. You may even be denied services you need and deserve.
Here are some ways you, as a Medicare beneficiary, can help stop Medicare fraud:
- Ask questions. You have a right to know everything about your care, including how much it costs.
- Keep a record of the dates of Medicare services received.
- Report suspected instances of fraud by emailing NCSMP@ncdoi.gov or calling toll-free 855-408-1212.
- Review your Medicare Summary Notices (MSNs) and Explanations of Benefits (EOBs):
- Did you receive the service or the product?
- Did your doctor order this service or product?
- Were you billed for a service or product more times than you received it?
- Were the services on your statement related to your condition?
- Don’t give your Medicare number to everyone who asks. Only your doctor or your other Medicare providers should need it.
- Don’t give your Medicare number to telephone callers or door-to-door solicitors.
- Don’t accept “free” medical services in exchange for your Medicare or Social Security number.
For more information, please visit www.ncshiip.com.