Prevent Medicare fraud: Protect your benefits during Open Enrollment
October is synonymous with pumpkin spice lattes, Halloween decorations and the kickoff of football season. But it’s also the beginning of Medicare Open Enrollment. Unfortunately, it’s also a prime time for scammers to target seniors.
Medicare fraud is big business for criminals, costing the program billions annually. Estimates suggest annual losses are around $60 billion, though the true figure may be higher. Fraud impacts everyone, as it drains funds from the essential healthcare services Medicare beneficiaries rely on.
The Colorado Senior Medicare Patrol (SMP), part of the Colorado Department of Regulatory Agencies (DORA), assists Medicare beneficiaries, their families and caregivers in identifying, preventing and reporting healthcare fraud, errors and abuse.
HOW TO PROTECT YOUR MEDICARE BENEFITS
According to SMP, you are the first line of defense. Here’s how to protect your benefits:
- Protect your Medicare card: Treat it like your bank card or social security number. Only share your Medicare number with trusted healthcare providers, insurers and people who work on your behalf.
- Beware of unsolicited offers: If someone you don’t know calls or visits your home offering medical services, think twice. Never give personal information to strangers.
- Review your Medicare statements: Check your Medicare Summary Notice (MSN) or Explanation of Benefits (EOB) for unfamiliar services or charges. If you see something you didn’t receive or that your doctor didn’t order, it could be fraud.
- Ask questions: If you notice errors or suspicious charges, contact your healthcare provider immediately to resolve the issue.
HOW TO TELL IF A MEDICARE PLAN SELLER IS LEGITIMATE
Before giving personal or financial information to anyone selling a Medicare plan, ask yourself these questions:
- Are they asking for your credit card or banking information?
- Have they requested your Medicare or Social Security number?
- Are they pressuring you to make an immediate decision?
If the answer is yes to any of these, hang up immediately—it’s likely a scam. Medicare will never call you unsolicited to sell a plan or ask for personal information unless you contacted them first.
PRESCRIPTION DRUG FRAUD
While reviewing your Medicare statements for services, don’t forget to check your prescription drug records. Prescription fraud is a common issue, with Medicare sometimes billed for drugs you never received or for medications that differ from what was prescribed.
To prevent prescription fraud:
- Review your Medicare statements closely: Look for discrepancies in your MSN or EOBs.
- Ask questions: If something doesn’t look right, contact your doctor or pharmacist for clarification.
WHAT IS SHIP?
The State Health Insurance Assistance Program (SHIP) helps Medicare enrollees navigate the complex Medicare system by providing free, unbiased and personalized information. SHIP volunteer counselors are not compensated in any way and do not sell insurance plans.
SHIP is supported by donations from individuals and businesses, as well as grants from organizations like the Colorado Division of Insurance (DORA) and the Administration for Community Living (ACL). If you think you’ve encountered fraud, error or abuse, contact a SHIP counselor:
- Mesa County RSVP: 970-243-9839 ext. 1
- Region 10 (Montrose & Delta): 970-765-3129
WHAT TO DO IF YOU SUSPECT FRAUD
If you suspect fraud, contact the Colorado Senior Medicare Patrol at 888-696-7213 or via email at [email protected]. You can also reach out to Medicare directly by visiting Medicare.gov or calling 1-800-MEDICARE (1-800-633-4227).
