Senior Medicare Patrol

What is Senior Medicare Patrol?

The Maryland Senior Medicare Patrol (SMP) empowers and assists Medicare beneficiaries, their families, and caregivers to prevent, detect, and report health care fraud, errors, and abuse through outreach, counseling, and education. There are 19 local SMP offices throughout Maryland, representing all 23 counties and Baltimore City. Contact your local SMP office for free, confidential assistance or to request a presentation or resources.

What is Medicare Fraud?

Medicare fraud happens when someone knowingly deceives Medicare to receive payment when they should not, or to receive higher payment than they should.
Medical identify theft is a type of fraud. This happens when a beneficiary’s Medicare number is misused, either by a provider, a supplier, a scammer, or by someone posing as the real beneficiary in order to receive medical care.
Medicare marketing violations occur when Medicare private plans present misleading information about what the plan offers and how much it costs. This is another type of fraud. Medicare Advantage and Part D plans must follow certain rules when promoting their products, including when and how they can contact you.
Medicare abuse occurs when questionable practices result in unnecessary costs to Medicare. Common types of abuse include billing for unnecessary services (services that are not medically necessary), overcharging for services or supplies, and misusing billing codes to increase reimbursement.
Medicare errors occur when a doctor, pharmacy or medical facility inadvertently makes a mistake when billing Medicare.

Look out for Common Fraud Schemes

Misleading Social Media Ads and Posts

When you are on social media sites, be careful of misleading ads and posts offering free spend cards, Medicare flex cards, and dental coverage. These ads and posts may lead the online user to a Medicare Advantage website to access these but, in turn, beneficiaries are signing up for different plans without realizing it.

Offers of Free Services, Equipment, and Tests

Be wary of calls offering free braces, genetic testing, health monitoring devices, even haircuts. Scammers may make these offers in exchange for your Medicare number. In fact, even if you say no to the offer, scammers may bill you. Do not share your Medicare number and review your Medicare Summary Notices for fraudulent claims.

False Claims on Your MSN or EOB

It is important to review your or your loved one's Medicare Summary Notices (MSNs) or Explanation of Benefits (EOBs) for false claims or potential scams. Sometimes you might get a delivery like COVID-19 tests or a knee brace that makes you aware something isn't right; however, not every scam has a physical delivery and, instead, is just a claim(s) on your statements, making them less obvious. The only way to know about these is to check your MSN or EOB. Look out for keywords such as diabetic supplies, hospice, therapy, urine analysis, genetic tests, orthotics, and telehealth.

Federal Imposter Scams

Be on the lookout for federal agency imposter scams. Imposters may claim to be from the HHS Office of Inspector General, Social Security Administration, Federal Trade Commission, Medicare, IRS, or another federal agency. Know that these agencies will not go door-to-door or call you unexpectedly. If you get a visit or call from someone saying they are with a federal agency, please don't give out your information. Hang up, close the door, and contact the agency they claimed to be from and report it.

Medicare is Not Issuing New Cards

A fraudster may call and say you need to activate, renew, or upgrade your Medicare card. They may ask for your Medicare number to “verify" your account, they may request that you pay a processing fee, or they may say you'll owe a fine if you don't renew your card. This is not true. Your card is not expiring and you never need to worry about a fine or a fee for your card. Never give your Medicare or banking information over the phone in these situations.

Upcoding and Add-on Services

One thing to look for when you are reviewing your Medicare Summary Notice (MSN) is called upcoding. This is when a provider bills for a more advanced billing code than the code that corresponds with the care provided. This action causes an increase in the payment received by the provider. If you receive psychotherapy services, watch for add-on services like Evaluation and Management (E&M) codes, which would imply a medical service was also provided during the psychotherapy session (PST).

Tips for Protecting Yourself

Keep a record of the health care services you receive. When you get health care services, record the dates, and save the receipts and statements you get from providers to check for mistakes. Contact us to request a free My Health Care Tracker to help you keep track.
Review claims on your Medicare Summary Notice (MSN) and/or Explanation of Benefits (EOB) for services or equipment you didn’t receive, double charges, or things your doctor didn’t order. Compare your MSN and EOB with your personal records.
Monitor your Medicare account. You don’t have to wait to view your Medicare claims. Simply log into (or create) your Medicare account at Medicare.gov to track your Medicare claims.
Treat your Medicare number the same way you would a credit card number. Don’t share your Medicare number or other personal information with anyone who contacts you by phone, email, or approaches you in person, unless you’ve given them permission in advance. Medicare, or someone representing Medicare, will only call and ask for personal information in these situations:

A Medicare health or drug plan can call you if you’re already a member of the plan. The agent who helped you join can also call you.
A customer service representative from 1-800-MEDICARE can call you if you’ve call and left a message or a representative said someone would call you back.
If you filed a report of suspected fraud, you may get a call from someone representing Medicare to follow up on your investigation.

Do not accept services you don’t need. If a caller or provider is pressuring you into getting tests or other services you feel are unnecessary, turn down care or ask to get a second opinion from another physician.
Be skeptical. It does not hurt to be wary if a caller or provider says Medicare will pay for services that do not sound medically necessary. Also be wary of someone calling to offer you free services or equipment that sound too good to be true.

Senior Medicare Patrol

What is Senior Medicare Patrol?

Look out for Common Fraud Schemes​

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Look out for Common Fraud Schemes

Contact your Local SMP