Tips for detecting and reporting Medicare fraud

Medicare fraud costs Americans an estimated $60 billion per year. It also affects Medicare beneficiaries in terms of time, stress and health.

About 60 people, mostly senior citizens, attended last week's Scam Jam— a fraud awareness event — and heard about how to detect and prevent health care-related scams from Armeta Coley, a senior Medicare Patrol coordinator with Upper Coastal Plain Council of Government.

"The Medicare Fraud Prevention Program is a program that teaches beneficiaries how to detect health care fraud and abuse and how to report it if you suspect your Medicare has been charged with something you didn't receive," Coley told those in attendance.

Coley said a good place to start in detecting Medicare fraud is keeping a healthcare journal of services provided, dates and times those services were provided and the business name of the provider.

The journal entries can be used to confirm the accuracy of Medicare Summary Notices, which are mailed out every 90 days, she said. Another source of information of what has been billed to a beneficiary's account is Medicare.gov, which also provides billing information about individual accounts.

"We ask that you keep a list of all of your doctors appointments and anything that is billed to your Medicare account," Coley said, adding that records are kept for Medicare Part A, Part B, Part C – Advantage Plan and Medicare Part D drug plans and other supplemental accounts.

Coley said other facts that beneficiaries should keep track of include benefit days used, claims approved or denied, non-covered charges, the amount Medicare paid, the maximum they may be billed and notes for what is claimed.

"Look to see if there were services you were charged for that you didn't receive," Coley said, adding that clerical errors often lead to mistaken charges in addition to those that are actual cases of fraud.

Coley also advised medical supply shipments be tracked to determine if what was ordered was delivered and if what was shipped to a beneficiary's account was actually ordered by a known health care provider.

Coley also warned beneficiaries to be judicious about purchasing Medicare Advantage plans by not immediately enrolling in plans pitched over the phone by telemarketers.

Last week's Scam Jam event was held at Word Tabernacle Church in Rocky Mount and was sponsored by the United Way Tar River Region, Upper Coastal Plain Council of Government and by the State Employees' and Coastal credit unions.

Other presenters at the Scam Jam event included officials with the N.C. State Attorney General's Office, the N.C. Department of Insurance and local law enforcement.

Businesses and nonprofit organizations were on-site to share details about resources and services available for community members to learn more about the scams and fraudulent activities confronting the Twin Counties community.

The United Way Tar River Region is a nonprofit agency that works to bring together people and resources to build a stronger community by investing donations into impactful, local programs that are targeting pressing needs in the community.