How a Senior Medicare Patrol Member Detected a Fake Charge in Her Own Bill

Jean Stone, who worked for the Centers for Medicare & Medicaid Services for more than 45 years, wasn’t expecting to find a fake claim in her own Medicare billing statement.

She had trained federal inspectors and the FBI to detect Medicare irregularities and testified in dozens of fraud cases. In retirement, she decided to become a Senior Medicare Patrol (SMP) volunteer in New York City and give presentations to volunteers and Medicare beneficiaries throughout the state about protecting themselves from Medicare scams.

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Dates listed put her in two places at once

Stone discovered she was a victim of Medicare fraud last year when she went to a pop-up COVID-19 testing location before attending an event. A few months later, when she reviewed her Medicare summary notice, which is Medicare’s explanation of benefits, she saw a $200 charge on the same day for a consultation with a cardiologist she had never met.

“It didn’t cost me a dime, but Medicare paid $200 for something it shouldn’t have paid for,” she says. “How many people does this happen to?”

Because she was an experienced Senior Medicare Patrol volunteer, she was able to report the scam charge to Medicare and the Department of Health and Human Services Office of Inspector General.

“There are so many complaints and so many providers, but they can see patterns,” she says. “The more complaints you get from real patients, the more credibility there is, not just a data anomaly.”

A volunteer’s advice on catching Medicare fraud

1. Review your Medicare summary notice for suspicious charges. Health care providers and hospitals send their bills directly to Medicare, which sends you a statement listing all services and supplies billed to the program in your name over a three-month period. It shows how much Medicare paid and the maximum amount you may owe a provider.

Jean Stone worked for CMS for more than 40 years. Now she helps people detect Medicare fraud.

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2. Review your Medicare claims more often than every three months. You can go to your online Medicare account to sign up to receive the Medicare summary notices electronically every month (eMSNs), or you can review claims at your online Medicare account within 24 hours of receiving a service.

3. Keep notes of the services you receive whenever you visit a doctor, so you can match that information with your summary notice for that date. Some state Senior Medicare Patrol programs, such as the one in New York, offer a personal health journal to help keep track of your doctor visits and services.

4. Contact the provider’s office if you have questions about any of the services on the statement. It could explain why the service appears or fix any mistakes. If you’re not happy with its answer — or if you see a bill on the statement from an unfamiliar provider — call your local Senior Medicare Patrol or 800-MEDICARE to report possible Medicare fraud.