Tips to Prevent Medicare Part D Fraud

Tips to Prevent Medicare Part D Fraud

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Are you getting the most out of your Part D benefit? Does your doctor prescribe less expensive generics when they’re available? Do you receive the correct number of pills in your prescription bottles? Learn several simple tips to make sure: you are making the best use of your drug benefits; you know how to prevent fraud and abuse, and you know how to detect fraud if it occurs.

  • Know your Part D plan carrier. Call the plan’s customer service number to ask for the plan’s preferred network pharmacy and use that pharmacy to get the best pricing.
  • Take your plan’s benefit booklet with you when you see your doctor. Show your doctor the plan’s formulary, or list of covered drugs, in the back of the booklet to ensure your medication is on that list.
  • Ask your doctor if you can take the less expensive generic drugs whenever possible.
  • Check your pill count. Make sure that the quantity of pills ordered equals the number of pills in the bottle, and you have not been “shorted”.
  • For mail order drugs, match the items shipped to those received. Notify the plan if you have been “short shipped” or the pill quantity count is wrong. Crooks steal pills and sell them on the street for big bucks!
  • Make sure you receive the correct medication. Did your doctor specifically prescribe a brand name and the pharmacy “substitute” a generic? If Medicare and our tax dollars paid for the more expensive medication, but you got a cheaper version, that equals fraud.
  • Check your billing to ensure that what is billed matchers what you actually received. Watch for double billing!
  • Never give your Medicare number over the phone, unless you called them and know with whom you are speaking.
  • Do not carry your Medicare card with you. Keep it at home in a safe place! Carry your Medicare supplemental insurance card and Part D cards only.

If you feel you have been scammed or fraud has occurred, call our Senior Medicare  Patrol helpline: 1-855-613-7080. For more information or a free counseling appointment, you can also call your local Health Insurance Counseling and Advocacy Program (HICAP) at 1-800-434-0222. See our Medicare Fraud section for more information on fraud.

Our blogger Karen J. Fletcher is CHA's publications consultant. She provides technical expertise, writing and research on Medicare, health disparities and other health care issues. With a Masters in Public Health from UC Berkeley, she serves in health advocacy as a trainer and consultant. See her current articles.

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