This document provides information about Medicare fraud and the Senior Medicare Patrol (SMP) program. It discusses how Medicare fraud affects taxpayers and beneficiaries by wasting funds and increasing costs. The SMP mission is to empower Medicare beneficiaries to prevent, detect, and report healthcare fraud, errors, and abuse through outreach and education. The document outlines the parts of Medicare, common types of fraud and abuse, and provides steps beneficiaries can take to detect and report suspected fraud, including reviewing statements for unauthorized services and contacting the SMP program for help.

1. What the Healthcare
Consumer Needs to Know
About Medicare Fraud?
Presented by: Marly Flores, Director, Virginia SMP
Funded by: The Administration on Community Living,
US Department of Health & Human Services

2. Medicare Fraud, Errors, and
Abuse Affect…
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Everyone
✓ Billions of taxpayer dollars
lost to improper claims
✓ Medicare trust fund at risk
Medicare Beneficiaries
✓ Higher premiums
✓ Less money for needed
benefits
✓ Quality of treatment

3. Consequences of Medicare Fraud,
Errors, and Abuse
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4. What is the Senior Medicare
Patrol?
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5. The SMP mission is…
to empower and assist Medicare
beneficiaries, their families, and caregivers
to prevent, detect, and report health care
fraud, errors, and abuse
through outreach, counseling, and
education.
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6. What is Medicare?
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7. Parts of Medicare
Medicare Supplement Insurance (Medigap) is not part of Medicare.
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8. Medicare Numbers and Cards
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9. What is Medicare Fraud?
Intentionally billing Medicare for
services that were not received, or billing
for a service at a higher rate than is
actually justified
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10. What is Medicare Abuse?
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Providers supply services or products
that are not medically necessary or that
do not meet professional standards

11. Examples of Fraud & Abuse
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12. What about Errors?
Only a review and investigation of the
issue will determine if it is an error,
fraud, or abuse.
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Health care services
and billing are
complicated, which can
lead to errors.

13. Real Life Cases: Medicare Fraud
& Abuse in Virginia!
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14. Three Steps to Prevent
Health Care Fraud
1) Prevent
2) Detect
3) Report
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15. Step 1: Prevent Medicare Fraud
and Abuse
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16. Step 2: Detect Medicare Fraud
& Abuse
✓ Use your Personal Health Care Journal
✓ Review Medicare Summary Notices (MSNs)
and other statements for:
1. Services you didn’t receive
2. Double-billing
3. Services not ordered by your doctor
✓ Access your Medicare information at
www.MyMedicare.gov.
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17. Step 3: Report Suspected
Medicare Fraud and Abuse
✓ Call the provider.
✓ Gather information and documentation.
✓ Contact Virginia SMP.
➢ 1-800-938-8885
➢ This is a free and confidential service!
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18. SMP Volunteers
Would you like to:
• Help other Medicare beneficiaries prevent,
detect and report?
• Community Advocate
• Community Educator
• Provide one-on-one counseling
18 Join the SMP program as a volunteer!

19. Contact Virginia SMP
Visit us online:
• www.virginiasmp.org
• www.facebook.com/virginiasmp
Toll-free: 1 800 938 8885
• To report suspected fraud/abuse
• To request a presentation and/or materials
• To volunteer with the SMP program
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20. Questions?
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