Understanding Medicare Changes: Part 4 of 4

Medicare fraud and abuse harms us all. You can be the front line in the fight against fraud. Here are some resources and information on how you can help.

Medicare fraud and abuse are very sensitive, yet very important, topics. Our presenters at our recent “Medicare…What Now???” presentation did a wonderful job explaining more about Medicare fraud and how we can band together to help fight fraud.

First, why fight fraud? Simply put, there is a pot of money for Medicare, and any time the system is abused, the money comes from that pot. Since that is money explicitly in place to help keep us healthy and get us better when we’re sick, it’s clear to see why such fraud is problematic.

So, how can we fight fraud? It’s actually quite simple. First, we need to be diligent about checking our EOB and MSN documents, also known as Explanation of Benefits and Medicare Summary Notices. These documents show a detailed account of the medical services that we have had provided, what was billed and what Medicare paid.

Within these documents, we can help fight fraud by carefully reviewing. For instance, were all the services listed actually performed? Is each service only billed once? Are items billed separately that should have been billed together?

A simple answer may be human error, so the first step should be to call your doctor’s office to alert them of any potential errors. If there is still something that is of concern, you can call Medicare at 1-800-MEDICARE or the Senior Medicare Patrol of New Jersey at 1-887-SMP-4359.

The Senior Medicare Patrol of New Jersey is part of a federally funded, national effort to combat Medicare fraud, waste, and abuse. They are a great resource for information, and can also provide you with a Personal Health Care Journal, so you can track your health services received throughout the year.