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Fraud & abuse

Protect yourself from scams & identity theft

Health care fraud affects all of us. It impacts the quality of health care. It also results in higher costs. Reducing Medicare fraud helps ensure that younger generations, like your grandchildren, will have Medicare when they need it.

What can you do?

Know what to look for. It can help you protect your identity and benefits. Beware of:

 

  • Calls or door-to-door visits to talk about health care items or services

  • People who offer money or gifts for health care services 

  • Bills for services or equipment you didn’t get, want or request

  • Shipments of medications, creams, or supplies you didn’t order or don't want 

  • Someone using your Medicare card to get medical care, supplies or equipment

  • People offering you free gifts or services in exchange for your Medicare ID number or health plan ID number 

Here's how to protect your benefits and your identity: 

 

Know who you’re sharing information with  
  

  • Don’t be afraid to ask questions if someone asks for your personal information. 

  • Beware of suspicious phone calls. Confirm who is calling and ask for a call back number. 

  • Never give out your Social Security, Medicare ID number, health plan ID number or banking information to anyone you don’t know. 

  • Medicare won't call you to ask for this information. We won't either because we have this information. 

  

Make sure your plan statements are correct  
  

If you get a bill for something that doesn’t look correct or that you didn’t receive, let us know. Carefully review your statements to: 

  

  • Make sure you received the services or items on your bill. 

  • Check the number of services or items on your bill. 

  • Be sure that the same service isn't on your bill more than once. 

  • Verify that the copayment amount is correct. 

Talk to your doctor about what items and services you need 

 

  • Beware of people that are calling on behalf of your doctor. Hang-up, and call your doctor’s office to verify.  

  • Don’t accept delivery of drugs, creams, supplies or braces unless you spoke to your doctor about them.  
     

Free services don’t require you to give out personal information 

 

  • Talk with your doctor about the items and services you need. 

  • Don’t accept items or services you don’t want. This includes medications, creams or supplies that are mailed to you. 

  • If someone offers you a free service, they shouldn’t ask for your health plan ID number, Social Security number or Medicare ID number. 

  
Remember: If the deal seems too good to be true, it probably is! 

If you see something suspicious or have a question about your plan statement, call us at the number on your ID card.   
  

You can always report your concerns anonymously. Aetna is a CVS Health company. To report your concerns to us anonymously, contact the  CVS Health Ethics Line. 

There are many different types of fraud, waste and abuse. It’s important to be able to identify these issues. This protects your identity and benefits. 

 

Online theft of personal information 

  

People may try to steal your personal or Medicare information online. They can harm you financially. They may also disrupt your Medicare benefits. 

 

It’s not always easy to tell the difference between an important email about your benefits and an online scam. An email may say there’s a problem with your account. Or it may ask for updated information to continue your Medicare coverage.  
  

What you can do:  
  

  • Delete or ignore suspicious emails. Don’t click on links or download attachments. 

     

    • Legitimate email addresses usually end in .com, .org or .gov.

    • Beware of emails with misspellings or bad grammar.

  • Don't give personal or financial information by email. 

  • Update your antivirus software regularly. Set up filters for junk or spam email. 

  • When in doubt, call us at the number on your health plan ID card.  
      

Visit the Medicare website 

 

 
Scams to convince you to change your coverage  

  

If you’re covered by both Medicare and Medicaid, you can change your health plan or drug coverage whenever you need to. However, scammers might try to get you to sign up for a plan that doesn’t fit your needs. 

  

What you can do:  
  

  • Only make changes that are right for you. 

  • Understand the differences between your current plan and new coverage options. 

  • Don't change your coverage if someone calls or visits your home without permission. 

  • Review your plan statements and other mailings to make sure no one changed your plan without your knowledge. 

  
Fake discount cards for prescriptions  

Discount prescription drug cards can save you money. But some scammers use fake discount cards to steal your identity or your money. Real discount cards are free – you should never pay for one. If you have Medicare Part D, most of your prescription drugs are already covered.  
  

What you can do:  
  

  • Talk to sources you trust, like your health plan and pharmacist. 

  • Avoid discount cards that ask for money or claim to replace Medicare. 

 

Telemarketing scams  
  

Many legitimate businesses use telemarketing. But criminals can also use live or recorded calls to try to steal your identity. Medicare won't call to ask for your bank account number, Social Security number, Medicare ID number or health plan ID number. We won’t either.  
  

What you can do:  
  

  • Hang up on recorded messages that ask you to verify your personal information. 

  • Don't press any keys or numbers when prompted — even if it's to take your name off their list. 

  • Never give your personal information to someone you don’t know. 

  • Report suspicious numbers to the Federal Trade Commission 1-888-382-1222 (TTY: 711). 

  

Online pharmacy scams  

  

Most online pharmacies aren't safe or legal. They might send you medicine that's tampered with, expired or fake. They could use your personal information to steal your identity.  
  

What you can do:  
  

  • Only order from online pharmacies in your health plan’s pharmacy network 

  • Don’t click on links in emails or pop-up advertisements on the Internet 

  • Don’t order from pharmacies outside the United States 

  • Report pharmacies that: 

     

    • Offer prescription drugs without a prescription

    • Won’t accept your prescription insurance card as a form of payment 

Home health agency fraud  

Home health services are only medically necessary if you’re confined to your home. Some home health agencies may take advantage of you and commit fraud.  
  

What you can do: 

 

  • Make sure that your doctor authorized your home health services. 

  • Make sure that your bill is for the number and type of home health visits you received. 

  
Medical transport services fraud  

  

Medical transport services are sometimes necessary. Some companies may bill Medicare for services you didn't receive such as Basic Life Support (BLS) — includes oxygen, cardiac (heart) monitoring and more.  
  

What you can do: 

 

  • If your bill shows BLS but you did not receive these services — report it! 

  
 Medical supplies fraud  

  

Medicare doesn't sell or mail medical supplies. If you get supplies that you or your doctor didn't order, you might be the target of a fraud scheme.  
  

What you can do: 

 

  • Refuse medical supplies that you didn't order. 

  • Return any medical supplies that are shipped to your home if you didn't order them.  

  • Report the company that sent them. 

  
Lab test fraud  

Your doctor must order genetic tests for Medicare to cover them. Some labs try to offer a free test in order to get your Medicare information. They may try to steal your identity or submit a fraudulent bill.  
  

What to do before you agree to genetic testing:  
  

  • Make sure your doctor ordered the test. 

  • Make sure the test is medically necessary and that we cover it.

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