Tips to Detect Medicare Fraud
  1. Always review medical bills, insurance Explanation of Benefits statements, and Medicare Summary Notices. Be alert for unexpected or unexplained charges for medical services, prescription drugs, supplies, or equipment.
  2. If you have Original Medicare, set up your private account on for 24/7 access to your claims history.
  3. Keep a journal and save your receipts. Compare this information to your medical statements. Are the dates correct? Did you receive the services or supplies? Do you recognize the provider’s name? Ask the SMP for a free Personal Health Care Journal.
  4. If Medicare denies a claim for a service because you supposedly already used the benefit or because it wasn’t medically necessary, perhaps a wrong diagnosis code or wrong Medicare number was entered on the claim, or maybe your Medicare number was stolen.
  5. If a collection agency or debt collector contacts you for an unpaid medical bill you can’t explain, someone may have used your Medicare number.
  6. If an insurance company refused to cover you because of a condition you don’t have, wrong information could be in your medical records. Ask your healthcare providers for a copy of your medical records. Also, find out who else received your health information. Look out for information about health conditions, surgeries, medications, and allergies that should or should not be in your medical records. Make sure errors are corrected. Wrong information in your medical records could be life threatening.   For information about your legal rights to your medical records see SMP Hawaii’s brochure, Medicare Identity Theft & Fraud.
  7. Each year, ask your insurance company to send you a list of all benefits they paid. Check for services you did not receive. Thieves sometimes change a victim’s contact information when obtaining services, so benefit payments and reports made to your plan number may not come to you.
  8. Reading your medical statements can be tough. The SMP offers free consultations. Make an appointment and learn about the latest healthcare scams and how to read your Medicare statements.


Report Fraud

If you suspect Medicare Fraud is occurring, please feel free to report it here today.  “Medicare fraud is defined as knowingly and willfully executing, or attempting to execute, a scheme or ploy to defraud the Medicare program or obtaining information by means of false pretenses, deception, or misrepresentation in order to receive inappropriate payment from the Medicare program.”




Tips to Protect    Tips to Report