By Kim Smallcombe, CHW, MMAP Regional/Program Coordinator, CareWell Services SW
The SMP is a national program to help Medicare recipients prevent, detect and report healthcare fraud, errors, and abuse. What may seem like an error could be fraud, abuse, or a billing coding error. Medicare fraud assumes criminal intent for profit or gain.
Common Medicare fraud scams include:
Ambulance Fraud. Medicare covers ambulance services only when medically necessary, when it is the only safe means of transporting to a hospital or skilled nursing facility.
Durable Medical Equipment. Medicare Part B covers this only when your doctor prescribes it. Don’t accept “free” equipment offers. Medicare will deny the claim, leaving you to pay the bill.
Genetic Testing (cheek swab). This can only be ordered by your doctor. Scammers advertise these as “free” cancer, DNA, dementia or Parkinson’s screenings, costing you thousands of dollars.
Medicare Marketing Violations. You receive Medicare Advantage Plan or Medicare Part D advertisements each year. They are allowed to mail these, but cannot call or visit unless you ask.
Don’t give your Medicare number to anyone over the phone, internet, or when signing in at presentations. Read your quarterly Medicare Statement for accuracy. Save packaging and invoices if you receive items not prescribed by your doctor.
Michigan Medicare Assistance Program (MMAP) counselors are trained for SMP to help you resolve errors, abuse, and fraud issues. You can reach your local MMAP office, at: (800) 803-7174
Want to know more and see recent results of SMP fraud investigations? Visit smpresource.org/news/