Pages 1--4

Who Pays? You Pay!
 
What is Medicare Fraud? 
How can I protect myself from Medicare Fraud? 
What should I do if I suspect Medicare fraud? 
Are speakers available on this subject?
 
Delaware Medicare Fraud Alert \ Seniors Fighting Medicare Fraud 1-800-223-9074 

1
What You Should Do If You Suspect 
Medicare Fraud 

First
 
Call your health care provider or Medicare insurance company 
for an explanation or clarification of unusual or questionable 
Medicare charges. The charge you question may be a billing 
error and easily corrected.
 
Second 

If you continue to have questions or concerns after calling your health care provider 
or Medicare insurance provider, call 
Delaware Medicare Fraud Alert at 


1-800-223-9074 (Delaware Division of Services 
for Aging and Adults with Physical Disabilities). Your call 
is free and confidential. 

Please refer to your Medicare 
Summary Notice when calling to provide pertinent information 
about the service( s) provided and explain why you believe 
Medicare should not have paid. Your question or concern will 
be investigated and you will receive an answer. 


Examples of Medicare Fraud 
& Abuse 

Billing for services or equipment not received. 

Overcharging for services or equipment. 

Altering claim forms to obtain a higher payment.
 
Using another person's Medicare card to obtain medical care.
 
Claims for services that are not medically necessary. 

Billing Medicare at a higher rate than non-Medicare patients. 

Additional payments re-quested even though the co-pay was covered by 
an insurance company. 

Soliciting, offering, or receiving a kickback, 
bribe, or rebate. For example, paying for 
a referral of a patient. 

2
How You Can Protect Yourself Delaware From Medicare Fraud 

Delaware Medicare Fraud Alert \ Seniors Fighting Medicare Fraud 1-800-223-9074
 
Review your Medicare Summary Notice (MSN) carefully!
 
Here are some examples to lookfor: 

Duplicate payments for the same services. 

Ambulance services you did not receive. 

Payments for home medical equipment while you were in a 
hospital or nursing home. 

Dates on the MSN that differ from the dates you actually 
received the service. 

Outpatient services billed while you were in the hospital. 


Ask questions, Consult your provider or your Medicare Office. 

If you do not understand the charges billed. 

If you do not think you received the billed service.

If you question whether a service was needed. 


Never ! ! ! 

Give your Medicare number to anyone other than service providers you know. 

Sign a blank form. 


Avoid ! ! ! 

Offers of "free" medical tests or supplies in exchange for your 
Medicare number. 

Health care providers who tell you that the item or service is not 
usually covered, but they know how to get Medicare to pay for it.
 
3
About Medicare/ Medicaid and Abuse 

According to research data, $13 billion of Medicare/ Medicaid dollars -your tax dollars -are lost due to fraud, waste, and abuse. The vast majority 
of health care providers are honest. However, $1 out of every $7 spent on 
Medicare and Medicaid, according to experts, is lost to fraud and abuse in 
areas such as home health care, skilled nursing facilities and durable medical 
equipment. 


Who pays? You pay! 


Speakers Available 

Trained senior counselors who represent the Delaware Medicare Fraud Alert 
program are available to speak to your senior center, civic or church group or 
other organization. You will learn why knowledgeable Medicare beneficiaries 
are our best weapon in the battle against Medicare/ Medicaid fraud, waste, and 
abuse, and how to protect yourself from health care fraud. To schedule a 
presentation, call 1-800-223-9074. Delaware Medicare Fraud Alert is a 
community-based outreach program sponsored by Delaware Health and Social 
Services, Division of Services for Aging and Adults with Disabilities. 


This publication was supported, in part, by grant #90AM2279 from the Administration on Aging, Department of Health and Human Services. Grantees undertaking projects under government sponsorship are encouraged to express freely 
their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official Administration on Aging policy. 
4