Detecting Fraud on Your Medicare Statements

Did you know that there is approximately $60 BILLION lost from Medicare every year due to Fraud, Error, and Abuse? That is a lot of money lost for the Medicare program. Unfortunately, most of the money lost is never recovered. Because of this, the best way to handle Medicare fraud is to prevent it from happening in the first place. We can do this by protecting our Medicare number and only sharing it with our trusted healthcare providers. But what if something does happen? How do we know if our number has been compromised?

Do you read your Medicare Summary Notice (MSN)?

The only way to know if our Medicare number is being misused is by reading our Medicare Summary Notice (MSN) or our Explanation of Benefits (EOB). These statements are mailed

out every 1-3 months and summarize all the services and products charged to your Medicare within the listed timeframe. You can also receive these electronically on www.Medicare.gov.

We should be reviewing these statements often. We are looking for the following:

• Products or services that you never received Example: Seeing a charge for a wheelchair that you were not prescribed.

• Double-billing Example: Being charged multiple times for a single back brace.

• Up coding Example: Having a $10 blood test charged as a $100 cancer screening.

Need help reading your MSN?

You can visit Medicare’s website to download sample MSN’s with a breakdown of each section of the MSN. The SMP National Resource Center also has an excellent 12-minute tutorial

about how to read an MSN on their YouTube channel.