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BY IRENE C. CARD and BETSY CHANDLER

NEWJERSEYNEWSROOM.COM

YOUR HEALTH INSURANCE

Medicare fraud is purposely billing Medicare for services that were never provided or received. Why should we care? The answer is very simple: Medicare fraud is costing the government billions of dollars per year. The government happens to be you and me! This means it is costing every taxpayer in America more money because of Medicare fraud.

Here are some examples of Medicare fraud: Billing Medicare or another insurer for services or items you never got. Billing Medicare for services or equipment which are different from what you got. Use of another person's Medicare card to get medical care, supplies, or equipment. Billing Medicare for home medical equipment after it has been returned.

You should be suspicious if the provider tell you that "the test is free; he only needs your Medicare number for his records. (Do not confuse this with clinical laboratory tests. There is no copayment and a provider may, in good faith, tell you that the test is free since there is no cost to the person with Medicare. However, Medicare will be paying the lab one hundred percent of the allowable charge for the clinical lab work that you had done).

That is a very obvious tip off that someone is committing fraud.

Be suspicious of providers that charge copayments on clinical laboratory tests, and on Medicare covered preventive services such as PAP smears, prostate specific antigen (PSA) tests, or flu and pneumonia shots. Be suspicious of providers who routinely waive copayments on any services, other than those previously mentioned, without checking first on your ability to pay.

If a provider advertises "free" consultations to people with Medicare, be leery. If someone uses pressure or scare tactics to sell you high priced medical services or diagnostic tests, don't use them. That is very suspicious.

A more common complaint is that you were billed for services that you never received. Do your homework before reporting that as fraud. I've had folks call me saying they were in the hospital and they got a statement from Medicare saying they paid a bill from a doctor they never heard of. There are doctors "behind the scenes" such as pathologists, radiologists, etc. They are entitled to be paid for their services even though you didn't see them personally. Your doctor may have asked a specialist to stop in and see you and you may have completely forgotten that he had been asked to see you. You can always get a copy of your hospital records if you are an in patient and these records should tell you which doctors have seen you.

To help prevent Medicare fraud you should report suspected instances of fraud.

Whenever you receive your Medicare Summary Notice (MSN), review it for errors. This notice shows you what Medicare was billed for, how much Medicare allowed and how much Medicare paid and what you owe. Make sure Medicare was not billed for services or supplies that you did not receive.

Here are some tips to prevent Medicare fraud:

• Do not ever give out your Medicare id number except to your physician and other medical providers.
• Do not allow anyone, except appropriate medical professionals, to review your medical records or recommend services.
• Do not contact your physician to request a service that you do not need.
• Be very careful in accepting Medicare services that are represented as being free.
• Be cautious when you are offered free testing or screening in exchange for your Medicare number!
• Be cautious of any provider who maintains they have been endorsed by the Federal government or Medicare. Neither the government nor Medicare endorse anyone.
• Avoid any provider of health care services or items who tells you that the item or service is not usually covered by Medicare but they know how to get it paid.

To report Medicare fraud, make sure you have researched your purported claim and that the services were never rendered to you. You may want to check with your physician's office first. You can call the hotline of the Office of the Inspector General at 1-800-447-8477. Have your Medicare Summary Notice in front of you when you call. You can write to the Office of the Inspector General, HHS Tips Hotline, P O Box 23489, Washington, D.C. 20026. They will not respond directly to written communications. You can also e-mail them at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

Much of the information in this article was taken from the Medicare.gov web site.

Irene Card & Betsy Chandler are both licensed insurance professionals working at MIC Insurance Services, a health insurance services company. If you have questions relative to this column or other related topics, we invite you to call (973) 492-2828, browse our past columns on our web site at www.micinsurance.com.

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