Health Care Fraud

Healthcare fraud is a scam in which individuals or organizations deceive the healthcare system to gain unlawful financial benefits. Seniors are particularly vulnerable to these scams due to their frequent interactions with healthcare providers, reliance on Medicare, and the complex nature of medical billing and insurance.

Types of Healthcare Fraud:

Medical Identity Theft:
Scammers steal your personal information, such as your Medicare number, to receive medical services or bill Medicare for services not provided. This can result in inaccurate medical records and denied claims when you need care.

Fraudulent Billing:
Healthcare providers might bill for services never provided, overcharge for services, or bill for more expensive services than those provided. This can lead to increased out-of-pocket costs for you.

Fake Health Insurance Plans:
Scammers might offer fake health insurance plans that don’t provide the coverage they promise. These scams can leave you without coverage when needed most, leading to high medical bills.

Fake Medical Devices or Treatments:
Scammers may try to sell you ineffective or unsafe medical devices or treatments, often claiming they are covered by Medicare when they are not.

How to Protect Yourself:

Review Medical Statements:
Regularly check your Medicare Summary Notices (MSNs) or Explanation of Benefits (EOBs) for services you didn’t receive. Call your healthcare provider to verify their accuracy if you notice any unfamiliar charges or services. If there’s any discrepancy, report it immediately.

Verify Healthcare Providers:
Always ensure that the healthcare providers you visit are legitimate and licensed. If someone contacts you offering medical services or devices, verify their credentials before proceeding.

Guard Your Medicare Number:
Treat your Medicare number like your Social Security number. Don’t share it with anyone who contacts you unsolicited, whether by phone, email, or in person.

What to Do if You Suspect Fraud:

Report to Medicare:
If you see something suspicious on your Medicare statement, report it immediately by calling 1-800-MEDICARE (1-800-633-4227).

Contact Your Insurance Company:
If you suspect fraudulent charges on your private insurance, contact your insurance provider’s fraud department.

Notify the Department of Health and Human Services (HHS):
The Office of Inspector General (OIG) investigates healthcare fraud. You can report suspected fraud at 1-800-HHS-TIPS (1-800-447-8477).