Senior Health Information and Insurance Education

Medicare Fraud, Waste and Abuse

How to identify and report Medicare fraud and abuse

We all pay a price for Medicare fraud, abuse and waste! It contributes significantly to rising health care costs. Trust your instincts and learn how to detect fraud.

Do you suspect fraud?

Contact us.

Watch out for these types of fraud

If you are:
  • Billed for services or equipment you didn't receive
  • Offered free testing or screening in exchange for your Medicare number
  • Charged for filling out claim forms
If a medical provider:
  • Performs services that exceed what's medically necessary
  • Offers or accepts referral fees from another provider for the referral
  • Misrepresents services that are billed to Medicare
  • Waives the 20 percent coinsurance or deductible

Senior Medicare Patrol
SHIINE is South Dakota's Senior Medicare Patrol (SMP) project. We can help Medicare beneficiaries prevent, detect and report Medicare and Medicaid fraud and abuse. If you have questions or suspect fraud or abuse, contact us.

Medicare fraud tips

  • Make sure you buy from a licensed agent. Ask to see their credentials.
  • Never give out personal information such as your Social Security, bank account or credit-card numbers over the phone unless you've initiated the contact.
  • Keep your receipts and bills, and compare them to your Medicare Summary Notice to be sure you received all the services, supplies, or equipment listed.
  • Be careful of any sales person who says he or she is from Medicare. Medicare does not send sales people to solicit your business.
Agents and brokers can't:
  • Market Medicare products or share plan details in doctor's offices, clinics, or pharmacy counters, or at educational events.
  • Offer free meals to potential clients listening to a Medicare sales presentation or for signing up for a particular plan.
  • Sell additional insurance products during any sales or marketing presentation for a Medicare Advantage or Medicare Part D plan.
  • Initiate unsolicited door-to-door visits, phone calls, emails or any other type of sales contact without your expressed invitation.

 
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