Checking health care statements is a great way to detect suspected Medicare fraud, errors or abuse. Persons with Original Medicare can review their Medicare Summary Notices (MSN) which are traditionally mailed every three months. The MSN shows all the services or supplies for which providers and suppliers billed Medicare during the three-month period, what Medicare paid, and what the consumer owes. An increasing number of Medicare beneficiaries also access their MSN online by setting up an account at Medicare.gov.
How does this prevent fraud, errors or abuse?
Creating a Medicare.gov account can be a crucial step in detecting errors, and even preventing fraud or abuse. Medicare beneficiaries can create an account with Medicare.gov and use it to check information about their coverage, enrollment status, and Medicare claims (if they have Original Medicare). The Medicare.gov account keeps all Medicare information private and is only accessible to the beneficiary through their unique log in information. Medicare.gov allows beneficiaries with Original Medicare to access important billing and up-to-date claims information rather than waiting for the quarterly mailed copies of the Medicare Summary Notices. In the event that a claim is wrongly filed, it’d be advantageous to catch that sooner rather than later.
Scammers hope that you don’t review your statements because if you don’t, then the fraudulent claims that they filed on your behalf will be paid and never questioned. As informed health care consumers, you can prevent, detect, and report suspected fraud by reviewing your statements and asking questions when something doesn’t seem right.
What actions should I take?
You should keep records of visits, lab work, or any other treatments for comparison purposes when reviewing an MSN. If something doesn’t look right, your first step is to call your health care provider for clarification or further explanation.
Set up your Medicare.gov account if you don’t already have one. The Centers for Medicare & Medicaid (CMS) created a Tips Sheet to assist with account setup and recovery of username and password as needed (note: an email address is not required for password recovery): click to open Medicare Account Tip Sheet (PDF).
Or for safe and confidential help, find a local SHIIP/SMP Counselor who can help you create your account, visit Iowa Medicare Resource page.
Whether you are working with a SHIIP/SMP Counselor or reviewing statements on your own, always remember to log out of your Medicare.gov account when you are done.
For more Fraud prevention news, visit Iowa’s Medicare Resouces fraud page.