Medicare Billing and Fraud – How to Protect Your Medicare Benefits

by Christopher Jackson, JD

Since 2008, Federal agencies and their law enforcement divisions have successfully recovered more than $10 billion in fraudulent payments made to individuals and healthcare providers. While this seems to be a hefty amount, these recovered payments represent only a small portion of the suspected Medicare fraud that occurs each year. Congress has allocated substantial resources to Federal agencies to assist in preventing Medicare billing fraud, but these resources only stretch so far. One of the best tools to prevent Medicare fraud is actually you, the Medicare beneficiary.

Every three months, Medicare sends beneficiaries a Medicare Summary Notice to give beneficiaries an overview of the services provided to them under Medicare Part A and Part B. By reviewing these Medicare Summary Notices, beneficiaries can find and report fraudulent billing practices to Medicare. Fraudulent billing practices include overbilling for a service rendered or billing for services never actually provided. While these Summary Notices can be confusing, they are a great resource for preventing fraud. The interactive articles below can help you easily understand your Medicare Summary Notice and explain what each section actually means for you.

How to Read Your Part A Medicare Summary Notice [AARP]

How to Read Your Part B Medicare Summary Notice [AARP]

Prevent Fraud [U.S. Department of Health & Human Services]

MMAP, Inc. Brochure on Medicare Fraud [MMAP, Inc. – A Local Michigan Resource for Medicare Issues]

In addition to providing Summary Notices to help educate seniors on their Medicare benefits, the Federal government has established the Senior Medicare Patrol (SMP) program. Through the SMP program, local organizations work to educate seniors on protecting themselves from Medicare fraud and abuse. The SMP program also works with state and Federal agencies to resolve complaints of fraud levied against health care facilities and providers. In Michigan, MMAP, Inc., a local resource for Medicare and Medicaid issues, is the state’s SMP partner.

If you believe billing fraud has occurred after reviewing your Medicare Summary Notice, you should contact MMAP, Inc. at (517) 886-1242 or the following Federal agencies:

Office of Inspector General

Call: 800-447-8477

Online: Report Fraud

or

Centers for Medicare and Medicaid

Call: 800-633-4227

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Christopher Jackson is an attorney at Elder Law of Michigan, and has been a member of the Elder Law team since early 2014. Christopher holds a Bachelor of Arts in Political Science and International Relations from the University of Indianapolis, and graduated with his Juris Doctor in 2013 from Michigan State University College of Law. As an attorney at Elder Law, Christopher provides legal advice to Michigan seniors on a wide-variety of areas, including estate planning, wills and trusts, Medicare/Medicaid, social security benefits, and insurance issues.