Keeping Your Money Safe: Preventing Medicare Fraud

Author: Denise Owens, SVP, Senior Manager, Fraud Operations 05/11/2023

As a person approaches 65 years old, they may start thinking about the federal health insurance program known as Medicare. Medicare is available to those 65 and older, certain young people with long-term disabilities, and people with End-Stage Renal Disease. While the program benefits millions of Americans each year, many patients, unfortunately, fall victim to Medicare fraud. If you or a loved one is insured by Medicare, it’s important to know how to protect yourself from fraudsters.

What is Medicare Fraud?

The first step in protecting yourself from Medicare fraud is understanding how it works. Medicare fraud typically involves fraudulent billing by a healthcare provider for products and services that the client did not require or did not request. The fraud is typically discovered by the provider’s bank.

For example, a bank may have a doctor or doctor’s office as a customer. The bank sees that the account is receiving Medicare payments that are not being used properly. This could be a healthcare clinic charging Medicare for tests or devices that a patient never received.

How to Protect Yourself from Medicare Fraud

To keep your money safe and avoid falling victim to Medicare fraud, it’s important to remember the following points:

  • Check your Medicare statement often to make sure you aren’t being charged for products or services you didn’t receive.
  • If a doctor is routinely waving your copay, even though services are not available without one, you should be skeptical.
  • Be skeptical of any doctor who tells you they can find a way to get Medicare to pay for products or services that aren’t covered.
  • If a provider is offering incentives or gifts to use their facility, that is a red flag.
  • Confirm who you are speaking to on the phone. Don’t give out any personal information over the phone, in a text, or through email.
  • It’s important to know, if you let someone use your Medicare card and they are not covered by Medicare, you are committing Medicare fraud. The card is only to be used by the owner of the Medicare insurance.

How to Report Medicare Fraud

To report Medicare fraud or abuse, you can call the U.S. Department of Health and Human Services Office of Inspector General’s tip line at 1-800-447-8477 or send an email to hhstips@oig.hhs.gov.

You might also consider calling 1-800-MEDICARE. You will be asked to provide:

  • your name and Medicare number
  • the name of the provider you’re reporting and any identifying information you may have
  • the service or item you’re questioning and when you are said to have received it
  • the amount of money that Medicare approved and paid
  • the date on your Medicare Summary Notice, health or drug plan’s Explanation of Benefits, or claim

(source: https://www.medicare.gov/basics/reporting-medicare-fraud-and-abuse)

Keeping Your Money Safe

Medicare fraud can happen when you least expect it. Don’t let yourself fall victim to fraudsters.

Keeping your money safe is as important to us as it is to you. PlainsCapital Bank’s Fraud Department provides educational resources for businesses and individuals to help detect and prevent fraud. For more information about our fraud prevention efforts, visit our fraud resources page.

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