Combatting Medicare Fraud: Tips for Beneficiaries

Medicare fraud poses a significant financial burden, costing U.S. taxpayers roughly $60 billion annually, though experts suggest this figure may underrepresent the total impact. Cultural factors, such as feelings of shame or guilt, contribute to underreporting in regions like Hawaii, explains Norma Kop, director of the Senior Medicare Patrol (SMP) of Hawaii. As Medicare offers health insurance to individuals aged 65 and older, as well as those with specific disabilities, it remains vulnerable to fraudulent activities.

With the commencement of National Medicare Fraud Prevention Week, experts stress educating beneficiaries to protect their healthcare benefits from fraud. SMP Hawaii's regular workshops teach Medicare beneficiaries, their families, and caregivers to decipher Medicare benefit statements to detect potential fraud. Medicare Summary Notices (MSNs) and Explanations of Benefits (EOBs) are crucial in spotting unauthorized medical claims, says Kop.

Fraudsters commonly exploit Medicare numbers to file false claims, using particular codes to gain higher reimbursements for costly services or medications. This fraudulent activity can impede legitimate claims, especially in hospice care scenarios. SMP encourages beneficiaries to scrutinize their Medicare statements for discrepancies. Their upcoming “Malama Your Medicare: Track It to Protect It” session, conducted via Zoom, aims to educate participants on identifying fraudulent claims. Resources like the "My Health Care Tracker" booklet and SMP Medicare Tracker App are available to assist in this effort, with numerous support options through SMP Hawaii to empower beneficiaries against Medicare fraud.