Help Spot Medicare Errors and Fight Fraud

Main Digest

Health care fraud costs Americans billions of dollars each year, but a careful reading of each Medicare Summary Notice can help consumers and their families fight back by spotting and reporting problems early.

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AARP's new Medicare Summary Notice "decoders," available at www.aarp.org/healthtools, provide visitors with an easy-to-use, interactive sample notice.

Clicking on each section of the page displays details to help users understand their Medicare statement and out-of-pocket health expenses, and potentially spot suspicious charges. AARP has created decoders for both Medicare hospital insurance (Part A) and medical insurance (Part B) notices.

"With health care costs already rising, people in Medicare and their families need every tool available to understand the services they pay for and crack down on the fraud and errors that cost them billions of dollars each year," said AARP Vice President Nicole Duritz. "Seniors and their loved ones can be a first line of defense by reviewing their Medicare Summary Notices every time and reporting problems to their providers or to Medicare."

Medicare Summary Notices are mailed four times each year to anyone in Medicare who received services or supplies during the previous quarter. Each notice shows all of the charges to Medicare for the patient, as well as dates, descriptions and billing codes.

AARP encourages seniors and their caregivers to review their notices regularly and follow these important tips to spot and report errors or fraud:

Compare Your bills

Do the dates, billing codes and the service descriptions on your Medicare Summary Notice match the statements and invoices from your doctor and other health care providers? In some instances, your notice may include valid charges for services or supplies you weren't aware you received - such as for medical consultations or tests. But, as a general rule, the dates and codes should match. If you don't see codes or other needed details on your provider's paperwork, ask for copies that include that information.

Contact Your provider

If you see an entry for services or supplies you believe you did not receive, contact the doctor or supplier listed. It may be a simple mistake that can be easily corrected. If it is, the corrected entry should appear on your next Medicare Summary Notice. If there's an entry for services or supplies that Medicare did not cover, but you believe is a covered service, call your medical provider's office to make sure the claim was submitted correctly. If it wasn't, ask the office to resubmit it.

Contact Medicare

If you still have questions about your Medicare Summary Notice, or there's something you and your health care provider cannot resolve, call 800-MEDICARE (800-633-4227).

Appeal a claim

If Medicare has not paid a claim you think it should have, you have the right to appeal. AARP's decoders link to more information about appealing a claim.

Duritz added:

"We can all improve the health care we receive and save money by being engaged patients, asking questions and pointing out mistakes. If you or someone you know is in Medicare, be proactive and protect yourself and your loved ones."

AARP's Medicare Summary Notice decoders are part of a suite of tools to help people navigate the health care system and save money on their care. AARP's health tools can be found at www.aarp.org/healthtools.

Attribution/Source(s):

This peer reviewed article relating to our AARP Insurance News section was selected for publishing by the editors of Disabled World due to its likely interest to our disability community readers. Though the content may have been edited for style, clarity, or length, the article "Help Spot Medicare Errors and Fight Fraud" was originally written by AARP, and published by Disabled-World.com on 2011/06/12 (Updated: 2023/06/11). Should you require further information or clarification, AARP can be contacted at aarp.org. Disabled World makes no warranties or representations in connection therewith.

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