AARP Webinar Q-and-A: Protecting Yourself From Health Care Fraud

The following questions were asked during AARP’s webinar series about the new health care law.

Q: What actions should people take if they encounter or suspect a health care scam?

A: If the pitch comes by phone or in person, you should try to get contact information, such as a name, phone number, business card and any specifics about whatever it is that’s making you think the pitch is a scam. Get just the basic information, even though it’s likely the phone number may be blocked and the names given to you may be fake. You want some information, but you also want to get off the phone as quickly as possible.

If the pitch comes by mail or e-mail, you should save it and forward that information to local law enforcement, your state attorney general, state insurance department or the Senior Medicare Patrol (SMP). If you think someone is trying to scam you over the phone, stay on the line long enough to get any contact information, then hang up. Do not share your personal information. If you receive something suspicious by e-mail, do not link to any website provided in the pitch or open any attachments.
 
Q: How can I check to see if false information is being provided about services provided to me or others?

A: The best thing you can do is to examine your Medicare Summary Notice or insurance Explanation of Benefits and ask yourself the following questions:

• "Are there any charges for something (services, equipment, medications) that I didn’t receive?"
  
• "Are there charges for services that are not medically necessary?"
  
• "Was I billed for the same thing more than once?"

If you see something on your statement that you don’t understand or that confuses you, call the provider.
 
Q: When a person reports fraud, is it anonymous?

A: Yes, you can report your concerns anonymously. Report Medicare fraud to the Inspector General of the U.S. Department of Health and Human Services:

• Phone: 800-HHS-TIPS (800-447-8477)
• Fax: 800-223-2164 (no more than 10 pages)
• E-Mail:  HHSTips@oig.hhs.gov
  
• Mail: Office of the Inspector General, HHS TIPS Hotline, P.O. Box 23489, Washington, DC 20026

 
Q: One type of fraud is upcoding. Should you report upcoding to the provider or report it to authorities as potential fraud?  

A: If you think there’s a coding error, it’s best to check with the provider first. What may appear to be upcoding could be a simple mistake. If you’re not satisfied with the provider’s response, report your concerns to Medicare or your insurance company.   

Q: Are there plans to simplify medical coding? I always read every bill and it is extremely confusing.

A: There is nothing in the new health care law that addresses the issue of simplifying medical coding. The codes, called CPT or Current Procedural Terminology, are developed by the American Medical Association’s CPT Editorial Panel.

Q: Is there any regulation for amounts charged for the same service at two different facilities?

A: Medicare, as well as most insurance companies, has a set fee schedule for each type of service. The Medicare-approved amount would be the same for the same service provided in the same geographical area. Different insurance companies have their own schedule of what payment is "usual and customary" for a particular service. They do not publish those schedules.

Q: How can I find out if a medical service was needed?

A:  Talk to your doctor if you have a question whether a service, such as a consultation with another professional or a lab test, was needed.