Most doctors, pharmacists, and other health care providers who work with Medicare and Advicare Advocate are honest. Unfortunately, there may be some who are dishonest. “Fraud” happens when Medicare or Advicare Advocate is billed for services or supplies you never got. The Medicare program loses billions of dollars each year. You’re important in the fight to prevent fraud in the Medicare Program. Take an active role in protecting your health care benefits.
The following is a list of tips from Medicare.gov to help prevent fraud. For more information on additional actions you can take, please go to their website at Medicare.gov – Tips to Prevent Fraud.
- Do protect your Medicare number (on your Medicare card) and your Social Security Number (on your Social Security card). Treat your Medicare card like it’s a credit card.
- Do remember that nothing is ever “free.” Don’t accept offers of money or gifts for free medical care.
- Do ask questions. You have a right to know everything about your medical care including the costs billed to Medicare.
- Do educate yourself about Medicare. Know your rights and know what a provider can and can’t bill to Medicare.
- Do use a calendar to record all of your doctor’s appointments and what tests or X-rays you get. Then check your Medicare statements carefully to make sure you got each service listed and that all the details are correct. If you spend time in a hospital, make sure the admission date, discharge date, and diagnosis on your bill are correct.
- Do be wary of providers who tell you that the item or service isn’t usually covered, but they “know how to bill Medicare” so Medicare will pay.
- Do make sure you understand how your plan works before you join.
- Do always check your pills before you leave the pharmacy to be sure you got the correct medication, including whether it’s a brand or generic and the full amount. If you don’t get your full prescription, report the problem to the pharmacist.
- Do report suspected instances of fraud
- Don’t allow anyone, except your doctor or other Medicare providers, to review your medical records or recommend services.
- Don’t contact your doctor to request a service that you don’t need.
- Don’t let anyone persuade you to see a doctor for care or services you don’t need.
- Don’t accept medical supplies from a door-to-door salesman. If someone comes to your door claiming to be from Medicare or Medicaid, remember that Medicare and Medicaid don’t send representatives to your home to sell products or services.
- Don’t be influenced by certain media advertising about your health. Many television and radio ads don’t have your best interest at heart.
- Don’t give your Medicare card, Medicare number, Social Security card, or Social Security Number to anyone except your doctor or other authorized Medicare provider.
If you suspect fraud as occurred, you can report it by doing the following:
- You can call Advicare Advocate Member Services at 1-844-564-0143 (TTY/TDD 711 or 1-888-357-7188), 8:00 a.m. until 8:00 p.m., seven days a week. Alternative technologies will be used on weekends and holidays.
- You can download, print and mail an Advicare Fraud Reporting Form to:
Attention: Compliance Dept.
531 S. Main Street, Suite RL-1
Greenville, SC 29601
- You can call 1-800-Medicare (1-800-633-4227). TTY users should call 1-877-486-2048.
- You can also report fraud by calling the Office of the Inspector General at 1-800-447-8477. TTY users should call 1-800-377-4950.
- You can learn more about how to report fraud in South Carolina by visiting the South Carolina’s Lieutenant Governor’s Office on Aging.
Advicare Advocate (Medicare-Medicaid Plan) is a health plan that contracts with both Medicare and South Carolina Healthy Connections Medicaid to provide benefits of both programs to enrollees. This information is available in other formats, such as Braille, large print, and audio. This information is also available for free in other languages. Please call our customer service number at 1-844-564-0143 (TTY/TDD 711 or 1-888-357-7188), 8:00 a.m. until 8:00 p.m., seven days a week. The call is free.
Esta información está disponible de forma gratuita en otros idiomas. Por favor llame a nuestro número de atención al cliente al 1-844-564-0143 (TTY/TDD 711 o 1-888-357-7188), 8:00 a.m. hasta las 8:00 p.m., los siete días de la semana. La llamada es gratuita.
This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the Member Handbook. Limitations, copays and restrictions may apply. For more information, call Advicare Advocate Member Services or refer to the Advicare Advocate Member Handbook. Benefits, List of Covered Drugs, pharmacy and provider networks, and/or copayments may change from time to time throughout the year and on January 1 of each year.
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Page Last Updated: July 15, 2015