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medicare fraud
Medicare Fraud

Medicare fraud is a BIG deal, and cases are on the rise.  The AARP estimates that fraud costs Medicare around $60 billion per year. Often, scammers will focus on getting people to agree to unnecessary at -home medical equipment. Callers may identify themselves as a government employee, insurance agent or “health care guide” and offer discounts or free durable medical equipment if you provide your Medicare number. When an unsuspecting elderly individual says they want the equipment, the caller will record their information and then sell it to a corrupt individual who may start billing for different services. Often times, beneficiaries either receive a subpar wheelchair or nothing at all. The problem comes back up when years later the Medicare patient actually needs a wheelchair but according to Medicare, they have already received one.

All CCHC employees are required to have training to help reduce the chances of Medicare fraud. In 2015, CMS removed Social Security numbers from cards and replaced them with new identification numbers, but this doesn’t necessarily mean fraud is less likely. At CCHC, we encourage you to protect your Medicare card like a credit card or Social Security card.

Jeri Whitford is a CCHC nurse who keeps track of Medicare fraudJeri Whitford, a CCHC employee who has been with CCHC New Bern Family Practice for 31 years, has witnessed many suspicious requests for Durable Medical Equipment (DME). Jeri considers herself the first-level defense and reaches out to patients when she receives an unusual request to make sure it is correct. The most common red flag for Jeri is a patient switching from a local supplier to a national company, often outside the state. Jeri’s advice to patients is “if you receive a phone call and you don’t have experience with the company, be suspicious.” Jeri encourages patients to be proactive and read their Medicare Summary Notices or explanation of benefits and make sure they’re correct. Jeri says, “if you see a claim for a back brace but you didn’t receive one, that’s a red flag.”

Medicare recommends taking the following steps to protect yourself and prevent fraud:

  • Don’t share your Medicare number. Only provide this information to doctors and health professionals
  • Remember Medicare doesn’t offer “freebies” or “sales” and will never call you to sell anything
  • Medicare will never contact you for your Medicare number or other personal information unless you’ve given them permission in advance
  • Medicare will never visit you at your home
  • You may get calls from people promising you things if you give them a Medicare number. Don’t do it.

If you suspect you may be a victim, call 1-800-MEDICARE