Preventing Medicare Fraud

How you can help fight healthcare fraud

 

UnitedHealthcare is committed to preventing fraud, waste and abuse in Medicare benefit programs and we're asking for your help. If you think you've seen or been a victim of fraud, please report it to us immediately. Not sure if what you've seen is fraud? We can help you with that, too.

 

If you are a plan member and think you have been a victim of fraud or identity theft related to your health information or Medicare coverage, we would like to talk to you. Please call UnitedHealthcare customer service at 1-877-699-5710 (TTY 711), 8 a.m. – 8 p.m., 7 days a week.

 

To report a potential case of fraud in a specific Medicare benefit program, you can also call UnitedHealthcare's dedicated fraud hotline toll-free at 1-877-637-5595, 24 hours a day, 7 days a week. TTY users call 711.

 

The fraud hotline allows you to report cases anonymously and confidentially and we'll make every effort to maintain your confidentiality. Please note: if law enforcement needs to get involved in the case you report, UnitedHealthcare will not be able to guarantee your confidentiality. But remember: UnitedHealthcare appreciates you coming forward and will not take any action against you for reporting a potential fraud case.

Examples of potential Medicare fraud:

 

  • A health care provider—such as a physician, pharmacy, or medical device company—billing for services that you never received.
  • A supplier—for example, a medical device company—billing for equipment that you did not want or receive, or billing for an item that has been returned.
  • Someone uses another person's Medicare card to get medical care, prescriptions, supplies or equipment.
  • A company offers a Medicare drug or health plan that hasn't been contracted by Medicare.
  • A company uses false information to mislead you into joining a Medicare drug or health plan.

Senior Medicare Patrol (SMP) Program can help.

 

The SMP Program educates people with Medicare to take an active role in detecting and preventing health care fraud and abuse. There is an SMP Program in every state, the District of Columbia, the U.S. Virgin Islands and Puerto Rico.

 

Find your local SMP Program

Beware of identity theft when looking at your Medicare coverage choices.

 

Remember to Guard your Card—keeping your ID card and personal information secure at all times is very important:

 

  • No one should call you or come to your home uninvited to sell Medicare products.
  • Medicare plans cannot ask you for credit card or banking information over the telephone unless you are already a member of that plan.
  • In most cases, Medicare can't call you to enroll in a plan—you must call them.
  • Only give your information to doctors or other providers YOU KNOW, plans contracted by Medicare, and to people in the community who work with Medicare, such as your State Health Insurance Program (SHIP) or Social Security.

 

If you think you've been a victim of identity theft or fraud and do not want to report it directly to UnitedHealthcare, you can also call any of these numbers/agencies below:

 

  • Call toll-free 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. TTY, call toll-free 1-877-486-2048, 24 hours a day, 7 days a week.
  • The Fraud Hotline of the HHS Office of Inspector General, toll-free at 1-800-HHS-TIPS (1-800-447-8477). TTY, call toll-free 1-800-377-4950. You can also email HHSTips@oig.hhs.gov.
  • The Federal Trade Commission's ID Theft Hotline toll-free at 1-877-438-4338 to make a report. TTY users, call toll-free 1-866-653-4261.
  • You can report potential prescription drug program fraud cases to the Medicare program directly, toll-free, at 1-877-7SafeRx (1-877-772-3379). For potential medical or non-prescription fraud cases, report to the Medicare program directly, toll-free, at 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. TTY, call toll-free 1-877-486-2048, 24 hours a day, 7 days a week. The Medicare fax number is 1-717-975-4442 and the website is www.medicare.gov.

 

For more information, request the guide titled "Protecting Medicare and You from Fraud" by calling toll-free 1-800-MEDICARE (1-800-633-4227). TTY/TDD users should call toll-free 1-877-486-2048. A customer service representative can answer your questions 24 hours a day, 7 days a week.

How Medicare protects you

 

Medicare works with other government agencies and with private companies to keep you safe from fraud.

 

You also have the right to control how your personal information is used.

 

You are protected from discrimination and cannot be treated differently because of your race, color, national origin, disability, age, religion, or sex. If you think you haven't been treated fairly for any of these reasons, call the Department of Health and Human Services, Office for Civil Rights for your state, or call toll-free 1-800-368-1019. TTY users, call toll-free 1-800-537-7697. For more information, visit the U.S. Department of Health and Human Services website.

Medicare Beneficiary Ombudsman

 

An Ombudsman is a person who reviews issues and helps resolve them. The Medicare Beneficiary Ombudsman shares information with the Secretary of Health and Human Services, Congress, and other organizations about what works well with Medicare—and what doesn't.

 

The Ombudsman helps improve the quality of services and care you get from Medicare by reporting problems and making recommendations.

 

The Ombudsman makes sure the following information is available to Medicare members:

 

  • Your Medicare coverage and services included or not included;
  • Information to assist you in making health care decisions;
  • Medicare rights and protections;
  • How you can resolve issues.

 

For more information about the Medicare Beneficiary Ombudsman, go to Medicare's website and click on "ombudsman."