Medicare Fraud & Identity Theft
What is Identity Theft?
Identity theft is a serious crime that occurs when someone steals another’s personal, identifying information for the purpose of using that information fraudulently. Personal identifying information includes Social Security numbers, Medicare and Medi-Cal ID numbers, credit card and banking account numbers, patient records, and computer usernames and passwords. Fraudulent uses for this information can include opening new credit accounts, taking out loans in the victim’s name, stealing money from financial accounts, or using available credit.
Sometimes identity theft is the result of a computer or institutional security breach. Other times, family members, friends, or acquaintances improperly access and use someone’s information for their own benefit. In other instances, strangers rely on the trusting nature of victims to solicit personal information to use fraudulently.
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How do I protect myself from Identity Theft?
Do not inadvertently contribute to identity theft! Be protective of your personal information. Beware of unsolicited calls, e-mails, and visitors requesting personal, identifying information. It is possible they are fraudulently impersonating financial, medical or insurance organizations. Before you trust a stranger with your information, verify they are who they say they are.
Let’s see some examples:
- Your telephone rings and you answer it. The person on the other line calls you by name and says, “Good morning. I am calling from the Nevada Social Security office and I need to update your personal information for our files.” You proceed to give the caller the requested information.
A few months later, you try to use your prescription Part D card at the pharmacy and are told you have no coverage. Why? The call you received a few months ago was not, in fact, from Social Security but from a private insurer that switched you to their plan.
- A family member uses your personal information to fraudulently impersonate you without your knowledge. Soon after they leave town, you discover they have maxed out a credit card in your name and emptied your bank accounts. You find yourself penniless and working with Adult Protective Services and the police to clean up your credit report and get back on your feet.
Don’t let these scenarios happen to you!
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What is Medicare Fraud and where would I see it?
Medicare Fraud occurs when someone INTENTIONALLY misrepresents services or equipment, resulting in payment of an UNAUTHORIZED benefit to a person or an organization. These fraudulent expenses ultimately cost the Medicare program and you, the beneficiary.
Examples of Medicare Fraud include:
- Fraudulent billings from nursing homes, residential facilities, hospitals, and hospices (Medicare Part A)
- Fraudulent billings for providers' services (Medicare Part B)
- Fraudulent billings for Durable Medical Equipment (DME) such as wheelchairs, walkers, electric scooters, and incontinence supplies
- Pressure sales, usually door-to-door or over the telephone, offering a free prescription plan (Medicare Part D)
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How can I protect myself from being a victim of Medicare Fraud?
You can protect yourself from Medicare Fraud by doing the following:
- Review your Medicare Summary Notice to ensure you did, in fact, receive the services, supplies or equipment for which Medicare has paid.
- Sign up with "My Medicare" to see your Medicare Summary Notices online at www.medicare.gov.
- Protect your Medicare and Social Security number.
- If someone is trying to convince you that you need a certain service, piece of equipment, or to see a doctor that you, in fact, do not need, DECLINE.
- Ask questions regarding what services you are receiving and why. BE INFORMED about your Medicare-billed care.
- NEVER purchase or accept medical supplies from door-to-door salespeople.
- Do not give out any of your personal information such as your Medicare number, Social Security number, banking information, and credit card numbers to anyone you do not know or whose business you did not solicit.
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What do I do if I suspect Medicare Fraud?
If you suspect Medicare Fraud, you can take some of the following steps.
- Call HICAP at 1-800-434-0222. Ventura HICAP belongs to the Senior Medicare Patrol (SMP) for reporting fraud.
- Call Medicare at 1-800-MEDICARE.
- Call the Inspector General’s Medicare Fraud Hotline at 1-800-477-8477.
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