What is Medicare/ Healthcare fraud?
To prevent healthcare fraud, you first need to know what it looks like. Healthcare fraud happens when someone bills your health insurance, including Medicare, for:
- Something you did not receive
- Something different than what you received
- Something that was not medically necessary
In short, someone is trying to bill your Medicare or insurance fraudulently.
Healthcare fraud is very common and occurs in every city, in every state, every day. If fraud happens to you, it is not your fault. Scam artists will do anything to gain our trust, and even the most sensible consumers can get “scammed.” But as the video points out, there’s something you can do and the Illinois SMP at AgeOptions can help!
How can you detect healthcare fraud?
The best way to detect healthcare fraud is to read your Medicare Summary Notice (MSN) or your insurance’s Explanation of Benefits (EOB). These documents show every claim billed to your insurance.
If you find a claim or charge for something that fits in the categories above, this may be a sign of errors, billing abuse or potential fraud. You can:
- Call the provider to ask about the claim of charge (if you know and trust the provider)
- Call the Illinois SMP at AgeOptions 800-699-9043 (ask for “SMP”).
Current Fraud Trend Tip Sheets
Downloadable Tip Sheets to help prevent current Medicare Fraud scams we are currently seeing throughout the country and in Illinois.
DME Scams
Genetic Testing
Home Health Care Fraud
Opioid Scams
Hospital Tip Sheets
Medicare Card Scams
Home Health Fraud
Fraud Alerts
We have a biweekly newsletter that is sent out to consumers, beneficiaries and caregivers that keep you updated on current scams, trends, and upcoming presentations. We cover what is not only what is happening in Illinois but the rest of the country and more!
[warning]
Who is the Illinois SMP?
The Illinois Senior Medicare Patrol (SMP) Program at AgeOptions empowers consumers to prevent healthcare fraud. With volunteers and program staff, we help people with Medicare and Medicaid to Prevent, Detect, and Report Medicare & Medicaid fraud, waste, and abuse. The Administration for Community Living (ACL) provides funding to SMP programs in all 50 states, Washington, D.C., Puerto Rico, Guam, and the Virgin Islands.
The Illinois SMP is headquartered at AgeOptions, the Area Agency on Aging of Suburban Cook County, and we work with several other agencies to provide information about healthcare fraud across Illinois. Our statewide partner agencies include the 12 other Illinois Area Agencies on Aging (https://webapps.illinois.gov/AGE/ProviderProfileSearch to find the AAA serving your county). To learn more about the Illinois SMP, visit www.illinoissmp.org
If you live outside of Illinois, visit https://www.smpresource.org/Locator/Default.aspx to find the SMP in your state.