Identity Theft and Fraud

Protect Yourself from Identity Theft and Fraud

Identity theft is a serious crime that happens when someone uses your personal information without your consent to commit fraud or other crimes. Personal information includes things like your name and your Social Security, Medicare, or credit card numbers. Don’t be a victim of identity theft. Guard against identity theft by taking action to protect yourself.

Most doctors, pharmacists, plans, and other health care providers who work with Medicare are honest. Unfortunately, there may be some who are dishonest. Medicare is working with other government agencies to protect you and Medicare. Medicare fraud happens when Medicare is billed for services or supplies you never got. Medicare fraud costs Medicare a lot of money each year. You pay for it with higher premiums.

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Identity Theft

Keep your personal information safe. You have control over when you provide and who you allow to have your personal information.

Generally, no one should call you or come to your home uninvited selling Medicare products. Don’t give your personal information to someone who does this. Only give personal information to doctors, other providers, and plans approved by Medicare, and to people in the community who work with Medicare, like your State Health Insurance Assistance Program (SHIP) or Social Security. Call (800) MEDICARE (800) 633-4227 if you aren’t sure if a provider is approved by Medicare. TTY users should call (877) 486-2048.

Medicare plans can’t ask you for credit card or banking information over the telephone, unless you are already a member of that plan. In most cases, Medicare plans can’t call you to enroll in a plan; instead, you must call them. Call (800) MEDICARE to report any plans that ask for your personal information over the telephone or that call to enroll you in a plan.

Reporting identity theft:

If you think someone is using your personal information, you can call any of these numbers:

(800) MEDICARE (800) 633-4227). TTY users should call (877) 486-2048.
The Fraud Hotline of the HHS Office of Inspector General at (800) HHS-TIPS (800) 447-8477. TTY users should call (800) 377-4950. You can also send an email to HHSTips@oig.hhs.gov.
The Federal Trade Commission’s ID Theft Hotline at (877) 438-4338 to make a report. TTY users should call (866) 653-4261. For more information about identity theft, visit www.ftc.gov/idtheft.

Medicare and Billing Fraud

When you get health care services, you may want to save the receipts you get from providers. Use your receipts to check for mistakes on statements you get. These include the Medicare Summary Notice if you have Original Medicare, or similar statements that list the services you got or prescriptions you filled. For example, members who have prescription drug coverage will receive an explanation of benefits statement each month. You should review these statements to make sure the information is correct.

The following are examples of possible Medicare fraud:

A health care provider bills for services you never got.
A supplier bills for equipment different than what was provided.
Someone uses another person’s Medicare or Member ID card to get medical care, supplies, or equipment.
Someone bills Medicare for home medical equipment after it has been returned.
A company offers a Medicare drug plan that hasn’t been approved by Medicare.
A company uses false information to mislead you into joining a Medicare plan.

If you believe a Medicare plan or provider has misled you, call (800) MEDICARE (800) 633-4227. TTY users should call (877) 486-2048.

Reporting Medicare and Billing Fraud

If you suspect Medicare/billing fraud, here’s what you can do:

Contact your health care provider to be sure the bill is correct.
Contact Member Services at one of the numbers listed below. You may also call our Compliance Hotline at (800) 453-3959 (available 24/7; reports can be made anonymously). For more information, visit fraud prevention on www.healthnewengland.org
Call (800) MEDICARE.
Call the Inspector General’s hotline at (800) HHS-TIPS (800) 447-8477. TTY users should call (800) 377-4950. You can also send an email to HHSTips@oig.hhs.gov.