California Health Advocates

Fraud & Abuse

California Health Advocates > Fraud & Abuse

Help Stop Medicare Fraud & Abuse
Protect, Detect, Report!

Let’s make Medicare stronger for all of us.

Fraud costs Medicare billions of dollars each year and fundamentally damages the Medicare program by raising the cost of healthcare for everyone. It is vitally important to root out fraud, and Medicare needs your help!

Protect

Protecting your personal information is the best line of defense in the fight against Medicare fraud and abuse. Take an active role in protecting your healthcare benefits:

  1. Protect your personal information. Guard your Medicare, Social Security and bank account numbers numbers carefully. Don’t give these to anyone over the phone or in person, unless you initiated the conversation, you know the person, and you write down their name, number and title.
  2. Don’t leave your Medicare number in a phone message, and don’t carry your Medicare card unless you will need it. Only take it to doctor’s appointments, visits to your hospital or clinic, or trips to the pharmacy.
  3. Don’t accept offers of money, free food or gifts for medical care. Watch out for incentives like “It’s free!” or “We know how to bill Medicare.”
  4. Don’t accept any offer of “free” services or supplies in return for your Medicare number. Don’t accept medical supplies from door-to-door salespeople. Medicare will never call or visit to sell you anything.
  5. Don’t let anyone convince you to see a doctor for a service you don’t need.
  6. Keep track of your doctor visits, tests and procedures by taking notes in a healthcare journal or calendar.

Detect

Even when you do everything right, there is a chance that you could be a target of fraud. Detect fraud by examining both the Medicare Summary Notice (MSN) you receive from Medicare after your claims are paid, and the Explanation of Benefits (EOB) you receive from your Part C and/or Part D plan. (Access your Medicare account at mymedicare.gov).

  1. Did you receive all the services/prescriptions listed?
  2. Were you billed for something you didn’t get?
  3. Did your doctor order these services?
  4. Do the prescriptions listed match your prescriptions?
  5. Were you billed for the same thing twice?
  6. Are the dates of the services/prescriptions correct?
  7. Are the dollar amounts shown the same as those on your bill?

See more examples of Medicare fraud…

Report

If you suspect fraud in your healthcare, report it!

  1. Call the health care provider listed on the Medicare Summary Notice or Explanation of Benefits and inquire about the questionable item(s). In many cases, it may be the result of a billing error, which can easily be corrected.
  2. If your question is not resolved and you still think the charges are fraudulent, call Senior Medicare Patrol: 1-855-613-7080.
  3. You can also contact the U.S. Department of Health and Human Services’ Office of Inspector General: 1-800-447-8477. Your SMP counselor will help you determine if this step is necessary.

Have your Medicare Summary Notice and/or Part D Explanation of Benefits ready when you call.

This webpage and associated linked pages are supported, in part by grant number 90MPPG0019-02-00  from the U.S. Administration for Community Living, Department of Health and Human Services, Washington, D.C. 20201.