Counseling Locations and Appointments
Last Updated:
10/8/08
Senior Health Insurance Assistance Program (SHIP)
(301) 590-2819
Senior Medicare Patrol (SMP)
Health
care error, fraud, and abuse affect everyone.
Last
year alone, Medicare lost nearly $13
billion to improper claims.
This
waste affects those who depend on Medicare and Medicaid by diminishing the
quality of the treatment they receive. It affects everyone who pays taxes by
wasting billions of tax dollars.
Prevention Tips
To help prevent
Medicare from losing critical funds, you should report all suspected instances
of error, fraud, or abuse.
·
Do not give out your Medicare
number except to your doctor or other Medicare provider.
·
Do not accept “free” medical
services or equipment in exchange for your Medicare or Social Security number.
·
Never give your Medicare number to
telephone or door-to-door solicitors (Medicare does not call or go door to
door).
·
Keep a record of the dates you
receive any medical services.
·
Review your Medicare Summary
Notice.
Ø
Did you receive the service or the
product?
Ø
Did the doctor order this service
or product?
Ø
Are you being billed for the same
service twice?
Ø Is the charge or service related to your condition or treatment?
What is Medicare Fraud?
Fraud occurs when an
individual or organization deliberately deceives others in order to gain some
sort of unauthorized benefit. Medicare and Medicaid fraud generally involves
deliberately billing for services that were not received or billing for a
service at a higher rate than is actually justified.
What is Medicare Abuse?
Health care abuse occurs
when providers supply services or products that are not medically necessary or
that do not meet professional standard.
Examples of Fraud and Abuse
ü Billing for services and supplies that were not provided.
ü “Free” services as part of a “study”
ü Equipment not delivered
ü “Up coding” – improper coding to obtain a higher payment
ü Unneeded or excessive x-rays and lab tests; claims for services that not medically necessary
ü Excessive medical supplies
ü Using another person’s Medicare card to obtain medical care
For assistance Call the
SMP Program
Senior Medicare Patrol Program
301 590 2819