The National Consumer Protection Technical Resource Center: The Center of Service & Information for SMPs

Health Care Fraud

1. Protect

2. Detect

3. Report

Detect

Learn to detect potential errors, fraud, and abuse.

Even when you do everything right, there is a chance that you could be a target of health care fraud. There are a lot of ways that your personal information can be used without your permission. 

Here are some steps you can take to detect potential errors, fraud, and abuse:

  • Always review your Medicare Summary Notice (MSN) and Part D Explanation of Benefits (EOB) for mistakes. Access to your current Medicare account is available 24 hours a day. Simply visit www.MyMedicare.gov.
  • Keep records of your health care visits, services and equipment provided, significant lab results, etc. The SMP personal health care journal or a pocket calendar is a good place to make notes.
  • Keep and file copies of any bills or notices from insurance companies, doctors, hospitals, pharmacies, etc., as well as cancelled checks.
  • Compare your MSN and EOB to your personal health care journal and prescription drug receipts to make sure they are correct.
  • Look for three things on your billing statement:
  1. Charges for something you didn’t get
  2. Billing for the same thing twice
  3. Services that were not ordered by your doctor
  • Ask questions – ask your provider or plan*:
  1. WHEN…you don’t understand the charges billed
  2. WHEN…you don’t think you received the service
  3. WHEN…you feel the service was unnecessary

*If your provider or plan do not help you, contact your local SMP.

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