Unveiling Medicare Fraud: Protecting Yourself and Your Premiums

Pick up a newspaper or watch the news and you’re likely to hear something about Medicare fraud. Scammers are continually finding new ways to cheat the system — and you.

As a Medicare recipient, it’s important to understand the nature of these schemes and the costly impact they have. Ultimately, Medicare fraud, waste and abuse drives up costs for the entire program, resulting in higher premiums for you and other enrollees.

What is Medicare Fraud, Waste and Abuse?

Simply put, Medicare fraud is the use of deception or misrepresentation to obtain benefits or payments. It can include billing for services not provided, forging signatures on documents or using another person’s Medicare card without consent.

Waste refers to practices that result in unnecessary costs to Medicare, such as overuse of services or inefficient processes.

Abuse involves actions that may indirectly result in unnecessary costs to Medicare, such as charging for services that aren’t medically necessary or providing substandard care.

Common Medicare Scams

• Phantom Billing: This scam involves providers billing Medicare for services or supplies that were never provided to the beneficiary. It often involves fraudulent claims for medical equipment, home health services or diagnostic tests.
• Medicare Card Theft: Scammers are stealing or illegally obtaining Medicare cards and using them to bill Medicare for fictitious services or supplies.
• Telemedicine Fraud: With the rise of telemedicine services, scammers are exploiting this platform to bill Medicare for unnecessary virtual visits. Be wary of unsolicited telemedicine offers, and only use trusted providers recommended by Medicare.
• Identity Theft: This common scam occurs when a thief uses your Medicare number to fraudulently obtain medical services or prescription drugs.
• Kickbacks and Referral Schemes: Providers may illegally offer kickbacks or financial incentives to beneficiaries in exchange for using their services or referring other beneficiaries.

Watch for Warning Signs

Key warning signs of Medicare fraud, waste and abuse include:

• Unsolicited offers for free medical equipment or services
• Pressure to provide personal or Medicare information
• Unexpected bills or statements
• Offers of cash or gifts in exchange for Medicare information
• Unsolicited requests for payment from Medicare providers

How Mutual of Omaha Protects You

Mutual of Omaha uses various strategies and resources to protect you from Medicare fraud. In 2023, our team of experts detected 860 questionable providers and found $35 million in savings by stopping checks for suspicious bills before paying them.

As scammers change their tactics, so do we. We’re always employing new tactics to complement our proven techniques to help us stay vigilant against Medicare fraud.

What You Can Do to Help

Combating fraud, waste and abuse in the Medicare system is essential for protecting individual beneficiaries, preserving the financial sustainability of the program and keeping your premiums affordable.

By recognizing the warning signs, being cautious of unsolicited offers and promptly reporting any suspicious activity, you can help protect your Medicare benefits and premium costs.

Remember to always safeguard your Medicare card and report any suspected fraud to law enforcement, Medicare, your state’s Senior Medicare Patrol and the Federal Trade Commission immediately.

Report Suspected Fraud

If you get a bill for services you didn’t receive, report it to Mutual of Omaha using our online fraud report form.

About the author

Tom Oldham is the Chief Compliance, Privacy, and Ethics Officer at Mutual of Omaha, bringing over a decade of regulatory compliance experience to the role. He works to safeguard our company and our customers from risks — including Medicare fraud.

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