Medicare Billing Fraud is a Growing Concern

Medicare fraud sign and stethoscope with papers.

How Medicare Beneficiaries Can Protect Themselves from Scams

By Whip Villarreal

Fraud has unfortunately become increasingly common in our daily lives. Medicare scams are also on the rise.

In addition to offering counseling services to help beneficiaries navigate the complexities of Medicare and Medicaid, the Michigan Medicare Assistance Program also provides guidance on identifying potential fraud and its implications. This component of their Senior Medicare Patrol services is essential for protecting beneficiaries, preserving program integrity, ensuring quality of care, and maintaining the efficient use of resources. By educating Medicare recipients, MMAP empowers them to be vigilant, informed about types of fraudulent activity, and proactive in their healthcare management.

Bradd Chisholm, a volunteer MMAP counselor, helps educate recipients on ways to protect themselves from potential scams. Having nearly fallen victim to suspected fraud himself, Chisholm is well-versed both professionally and personally in identifying red flags and navigating these situations. Because of his experience, he is in a unique position to effectively inform program participants about the dangers of Medicare fraud.

“Do not give your Medicare number to anybody; guard it like your Social Security number…”

Bradd Chisholm, volunteer MMAP counselor

“Some provider billed Medicare on my behalf for thousands of urinary catheters in 2023,” recalls Chisholm. “I noticed it on my Medicare summary notice that I review every month. I never received these items and my doctor never told me that I needed them. It was a red flag that this was either an error, which I doubt, or outright fraud. The more you research it, the more apparent it becomes that scams involving urinary catheters are prevalent in the U.S.”

Since reporting the charge, Chisholm has not received a bill for co-pays or deductibles. However, the charge still appears in his summary notice. Although he has not been provided an official update from Medicare, he considers it an isolated case and continues to monitor for fraud through his summary notices.

A selfie of Bradd Chisholm
Bradd Chisholm, volunteer MMAP counselor

Chisholm advises Medicare recipients to scrutinize their Medicare summary notices regularly and report any suspicious activity immediately. Recipients can report suspected fraud by contacting MMAP.

Financial repercussions of Medicare fraud can be severe. Recipients may face unexpected bills for services they never received, and they may end up paying additional charges. Generally, Medicare covers 80 percent of an allowable charge, with the remaining 20 percent billed directly to the recipient or their supplemental insurance. If the Medicare insurance supplement deems that portion of the charge is not payable, then the person would be responsible for the uncovered amount, which could be substantial. Chisholm suggests verifying providers and checking with insurance companies for reputable options to prevent becoming a victim of fraudulent charges.

Furthermore, recipients should guard their Medicare number and never share it with someone they do not know. He warns against sharing the number over the phone and recommends requesting a new number directly through Medicare if they confirm or suspect that their Medicare number has been compromised.

“Do not give your Medicare number to anybody; guard it like your Social Security number, and only give it to providers with whom you are doing business,” Chisholm cautions. “If someone calls you to verify your Medicare number, never do so over the phone in any circumstance. Hang up and do not engage because scammers are trying to get the number for fraud, not to verify it. My advice to those I work with is if you don’t know them, hang up and move on; don’t engage.”

For more information about preventing, detecting, and reporting alleged Medicare fraud, visit MMAP’s Senior Medicare Patrol page.