Frequently Asked Questions About Stopping Health Care Fraud

We know for many people health care fraud and abuse can be confusing and intimidating. To help reduce the confusion, we have answered the most frequently asked questions about how to protect against, detect, and report health care fraud.

How to Identify Common Scams

There are countless ways that your personal information can be stolen and used without your permission or knowledge. The SMP Resource Center has outlined the following steps for identifying signs of potential health care fraud and abuse:

• Always review your Medicare Summary Notice (MSN) and Part D Explanation of Benefits (EOB) for mistakes. Access to your Medicare account is available 24 hours a day at www.MyMedicare.gov.
• Keep records of your health care visits, services and equipment provided, significant lab results, and other details. The SMP personal health care journal or a pocket calendar is a good place to keep notes.
• File copies of any bills or notices from insurance companies, doctors, hospitals, pharmacies, and other health care providers, as well as cancelled checks.
• Compare your MSN and EOB to your personal health care journal and prescription drug receipts to make sure they are correct.
• Look for three things on your billing statement:
  1. Charges for something you didn’t get
  2. Billing for the same thing twice
  3. Services that were not ordered by your doctor
• Ask questions! Ask your provider whenever:
  1. You don’t understand the charges billed
  2. You don’t think you received the service
  3. You feel the service was unnecessary

Download an SMP fact sheet with frequently asked questions and answers.

• SMP Frequently Asked Questions Fact Sheet (for print)
• SMP Frequently Asked Questions Fact Sheet (for web)

To learn more, please visit: http://www.smpresource.org/Content/NavigationMenu/Health careFraud/Detect.htm

Find an SMP Near You 

To obtain more information on how to protect against, detect, and report Medicare fraud or receive help from one of our Medicare fraud experts, please use the National Consumer Protection Technical Resource Center’s (SMP Resource Center) Locator tool to find the nearest SMP office to you.