Missouri SMP

Are You Smarter Than A Scam Artist?

How much money is believed to be lost to Medicare/Medicaid fraud and abuse each hour?

$5,000

$50,000

$100,000

$7 million an hour

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Approximately $7 Million an hour! Reporting Medicare fraud, errors and abuse helps protect the program.

What are the 4 R’s of Medicare?

A. Record, Review, Report, Remember

B. Respond, Receive, Review, Regret

C. Report, Revise, Regret, Remember

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A. Record, Review, Report, Remember are the 4 R’s of Medicare.

First, RECORD all medical appointments, tests or other services on a calendar or journal. Save all statements and receipts.
Next, REVIEW your Medicare Summary Notice or your Explanation of Benefits and compare to your recorded bills and dates.
If you need to REPORT, call the Missouri SMP at 888-515-6565.
Finally, REMEMBER to keep your Medicare number in a safe place.

When you are reviewing your monthly statement, you notice you receive a Medicare Summary Notice (MSN). However, your sister-in-law gets an Explanation of Benefits (EOB). What is the difference?

A. An Explanation of Benefits is printed on recycled paper with soy-based ink and delivered by special courier.

B. If your benefits coverage is from a Medicare Advantage Plan (called Part C), you will receive an Explanation of Benefits from your plan provider.

C. MSN and EOB statements both detail coverage decisions and payments made on a beneficiary’s behalf, but the letters do have different formatting.

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Answer B. and C. are correct. Both MSN and EOB statements supply important information, but you will only receive an EOB if you are part of a Medicare Advantage plan.

When you study your MSN or EOB, you notice a charge for a service you did not receive. What should your first reaction be?

A. Immediately suspect fraud or abuse.

B. Consider whether this may be an innocent human error in billing or a coding mistake.

C. Call Judge Judy.

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Answer A. Question whether it might be potential fraud or abuse. Call your physician’s office and discuss your questions as a first step. However, please understand that this might be an error as Medicare is complex. It’s common to see billing mistakes and other innocent human errors.

Which of the following type of waste in Medicare has the largest impact on the Medicare program?

Fraud

Errors

Abuse

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Answer A. Fraud is the worst level, and these schemes are complex and often involve elements of organized crime. Authorities must prove that scheme was “intentional” and executed “knowingly” to call it fraud.

You receive a phone call from someone who claims to work at Medicare and says that you are due a refund. To process the refund, they need you to give them your Medicare number and bank account information. You should:

A. Ask the caller to wait while you gather your Medicare card and checkbook.

B. Hang up. This is a scam!

C. Give your information, then give your sister-in-law’s phone number so they can call her, too.

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Answer B. Hang up. Medicare will contact you through the mail. If you are due a refund, they will send it through the mail. They will not call to inform you or ask you to verify your information.

You are running late for a doctor’s appointment, and there is no way you’ll make it on time. Will Medicare pay the costs of an ambulance transport?

A. Yes, because the trip is going to a doctor’s appointment.

B. No, you might be able to use a wheelchair van or car without endangering yourself.

C. No, because an ambulance may not be the only means of transporting the patient safely.

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Answer B. and C. Medicare has several criteria that must be met before they will cover the cost of an ambulance. There have been suspected fraud cases of scammers billing nonemergency trips as emergency trips.

Learn more about Medicare Ambulance coverage at Missouri CLAIM at 800-390-3330. For billing errors or concerns, call Missouri SMP at 888-515-6565.

The new Medicare cards are still valuable to identity thieves, but no longer include your _________ on it.

Social Security Number

Gender

Start date of Medicare

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Answer A. Your Social Security Number no longer appear on Medicare cards.

You receive a bill from a physician that you have never seen. “Book ‘em, Danno”…as this is definitely a case of fraud.

True

False

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Answer B. False. The bill might be from a radiologist who read an x-ray, for example.

What should you carry in your billfold in case you need emergency care?

A. Social Security Card

B. In Case of Emergency Card

C. Medicare Card

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Answer B. In Case of Emergency Card (ICE). Only carry your Medicare card with you if you are going to receive healthcare services. An ICE card will have information such as who to contact as well as a list of medications and allergies. Contact the Missouri SMP if you would like an ICE card.

What are the things a scammer must have to commit fraud?

A. Healthcare providers who bill for services

B. Beneficiaries’ numbers to be used for billing

C. All of the above

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Answer C. All of the above. Scammers need both a provider and a beneficiary in order to bill Medicare. If they don’t have both, the scammer would be unable to submit claims.

Scammers can’t “hack” your Caller ID system. You can always trust the name that comes up on the screen to be completely accurate.

True

False

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Answer B. False. Scammers use automated dialing software to set up robocalls. According to the FTC.gov website, this is called Caller ID Spoofing. Scammers can also set your display to show the name of your bank, for instance. They can even use phone numbers that appear to be local.

Your sister-in-law got a phone call from a telemedicine company saying that her cardiologist wanted her to take a cardiovascular genetic test. She agreed to order the test and gave out her personal information over the phone. What should you do?

A. Tell her to call the Missouri SMP at 888-515-6565 to report a suspected billing error or possible fraud.

B. Ask her for the phone number of the telemedicine company and get your own kit.

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Answer A. Call Missouri SMP. Genetic testing scams are a real problem.

Look for the words “gene analysis,” “molecular pathology,” or “laboratory” on your MSN or EOB. Be sure to report anything you find to Missouri SMP.

Your community center is sponsoring a wellness fair. At one of the booths, a vendor offers a “free” DNA swab kit to see if you are likely to get cancer. They tell you Medicare will pay for the test. You should:

A. Say “no”, walk away and report this as a possible scam to the community center director.

B. Take the swab kit, mail it in along with the card that asks for your name, address, birthday and Medicare number.

C. Call 9-1-1 to report a crime in process.

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Answer A. Report any concerns about a possible scam to the community center director.

You receive a phone call from a very pushy woman who wants to send you a laminated copy of new Medicare cards. All she needs is to have you verify your Medicare number and home address. She won’t take “no” for an answer! Is it true that there are new laminated Medicare cards?

True

False

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Answer B. False. Don’t believe callers claiming to be with Medicare, saying they are issuing laminated or microchipped Medicare cards. Hang up the phone on these rude scammers!

Which of the following can you use to record your tests, scans, prescriptions, and visits. It can also help you cross-check any services detailed on your Medicare Summary Notice or Explanation of Benefits?

A. A credit card statement

B. A personal calendar or journal of health appointments

C. Your cable TV bill

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Answer B. A personal calendar or journal of health appointments, such as the Missouri SMP My Healthcare Tracker. Contact us at 888-515-6565 to request one to be mailed to your home.

You get a voicemail message that sounded very professional and polite. “This is your doctor’s office. You are eligible for a back brace to help with your pain. Please call us back at a number with a local area code for more information.” What do you do?

Call the number and have a conversation with them. Order the back brace after giving your personal information to the nice lady on the phone.

Call your doctor’s office to see if they called you.

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Answer B. Call your doctor’s office to see if they called you. It’s also well worth your time and effort to check the company phone number yourself on their website or from a past bill.

How do you know if Medicare has paid for a service that you did not receive?

A. Call Medicare.

B. Review your Medicare Summary Notice or Explanation of Benefits.

C. Wait for a statement from your doctor.

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Answer B. Review your MSN or EOB. Look for charges for something you didn’t receive, double billing for the same service and services that were not ordered by your doctor.

The main difference between Medicare fraud and _____ is intent.

Fraud

Abuse

Errors

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Answer B. Abuse. Remember that authorities must prove intent before it can be considered fraud.

If you receive an official-looking COVID-19 survey that asks for personal, medical, or financial information, what should you do?

A. Read the fine print to see if they are offering money or gifts in exchange.

B. Fill it out, then take a photo of the completed survey and post it to your Facebook account.

C. Toss this fake medical survey in the garbage and/or delete emails without clicking any links.

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Answer C: It’s best to be careful during health emergencies like COVID-19. Unfortunately, scammers all too often seize the opportunities to take advantage of people. Protect your information!

Should you take advice or offers of medical services from people you don’t know who call, come to your house, or approach you in public?

Yes

Maybe

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Answer B: No! Medical information is very valuable. Protect it by treating your Medicare card like a credit card.

You attend a diabetes education seminar. At the seminar, you are offered free diabetic shoes. The speaker states that he will take care of all of the paperwork for you. You should:

A. Avoid the offer. Your physician will order what you need.

B. Speak with your physician to decide if shoes are needed.

C. Order the shoes. Customer service like this is hard to come by.

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Answer A or B. Medicare will only cover items from your physician’s orders. People offering Durable Medical Equipment is a common scam…don’t get fooled by this one!

You are contacted by a company who offers you a scooter, at no charge. When you receive the Medicare Summary Notice, you notice that Medicare has been billed for a power wheelchair. You should:

A. Do nothing. Medicare considers scooters power wheelchairs.

B. Report the concern because Medicare was billed for more than you received.

C. Ignore it. They’ll work it out.

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Answer B. Report the concern to Missouri SMP at 888-515-6565. Your physician must prescribe mobility equipment for you. A company should not be contacting you. Also, power wheelchairs are paid for by Medicare at a much higher rate than scooters.

“Free” blood pressure screenings are offered at a mall. When it’s your turn, the lady asks for your Medicare number. Should you be suspicious?

Yes

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Answer A. Yes. If a service is being offered for free, they don’t need your Medicare number. Keep shopping and don’t get fooled by this one!

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If you want us to present this program to a group or have any questions, contact us.

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