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Medicare EOB received in error or fraud - report?

chazix

chazix

Of course it works - I fixed it!
Subscriber
My better half received a Medicare Explanation of Benefits for treatment she didn't have, in a place she hasn't been (nearly 2000 miles away). The EOB says the treatments were not approved, but also says Total You May Be Billed is zero.

Should we report this to Medicare? I'm fearful that the response will be "Okay, no problem, we'll just disable her Medicare number", and I fear what it would take to re-establish coverage.

Thanks for ideas, especially if you have had a similar experience.
 
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chazix said:
My better half received a Medicare Explanation of Benefits for treatment she didn't have, in a place she hasn't been (nearly 2000 miles away). The EOB says the treatments were not approved, but also says Total You May Be Billed is zero.

Should we report this to Medicare? I'm fearful that the response will be "Okay, no problem, we'll just disable her Medicare number", and I fear what it would take to re-establish coverage.

Thanks for ideas, especially if you have had a similar experience.
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I believe it should be reported.. I know we are dealing with the government, but for reporting a scam to your local SSA office shouldn’t cause you to have your number revoked or a benefit loss. You are reporting what they request be reported. Your Medicare number isn’t like a credit card to be revoked or replaced. Have you established an online account at Medicare.gov ? Check there to see more details and information. Your EOB stating you owe 0, I think is a good indication that Medicare may already be aware of the situation. Hope that helps
 
Perhaps I should emphasize that I'm VERY motivated to expose fraud, if that's what this is. I'm just not confident that we won't be at risk by reporting it.

I guess, in my dream world, what I would love to hear is that one of us at AK has made a similar report, and NOT ended up regretting it.

(Probably I should reveal that I've spent 10-20 hours lately arguing with a cable service that's been trying to extort $$$ from us for bogus reasons. So, I might be a tad over-sensitized to the pitfalls of dealing with large organizations where all the employees are well-meaning, but The System won't let them Do The Right Thing.)
 
So rather than reporting something as fraud that you don't actually know at the moment, I suggest calling them at a number from the official website but not any number or website address from the letter you received.

Ask them what it's about and base further responses/questions off that. I don't think you need to go in with allegations/assertions of fraud up front.
 
DesertRatt said:
Right. A simple response is: I never visited this medical facility, I never had this procedure, and I don't know why it is on this EOB.
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:thumbsup:

It’s best to just tell the truth, as you know it. Plain and simple, no embellishments. That way, when the crazy govt (or any business you are dealing with) gets back to you 20 or 30 times, you’re less likely to mess up.
 
chazix said:
So, no bad consequences from reporting? Thanks!
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It has been some years so talked to my wife to refresh my memory.
She called Medicare and reported it. Called our supplemental first probably and they gave her the advice to call Medicare and reported it. Believes she just left a message not sure if talked to anyone. The supplemental people she did talk to.
It was also a bill from a facility in another state hundred of miles away.

She got a new card with a new number months later maybe over a year.
 
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