A northwest North Dakota senior who discovered an unusual charge on her health insurance statement last year made the right call. She contacted her supplemental insurer and Medicare to report suspected fraud.

Identity theft involving Medicare is a multi-billion-dollar crime in the United States. Identity theft happens when someone uses your personal information without your consent to commit fraud or other crimes. Personal information includes data such as your name, Social Security or Medicare number, a credit card, bank account numbers or Medicare account username and password.

In the case of the local identity fraud victim, who chose to remain anonymous, she received an Explanation of Health Care Benefits document in November 2020, stating that Medicare paid $3,870 toward a $5,400 bill. Unaware of any medical care prompting the bill, she contacted her medical providers, who confirmed she had no charges pending with them. She reported to her supplemental insurer and to Medicare, which pursued and eventually resolved her errant bill this past fall. The bill from a San Diego, California, laboratory was purportedly for services in early 2020.

The area woman’s advice to other seniors is to examine their insurance statements closely. Because statements can be confusing, she admitted she hasn’t always followed her own advice, but she said she now understands how important that vigilance is.

The U.S. Department of Justice has prosecuted billions of dollars of Medicare fraud in recent years. In September 2020, the department announced a historic nationwide enforcement action involving 345 defendants, including more than 100 doctors, nurses and other licensed medical professionals. The defendants were charged with submitting more than $6 billion in false and fraudulent claims to federal healthcare programs and private insurers.

In May 2021, criminal charges were brought against 14 defendants, some previously charged in other indictments, for fraud schemes that exploited the COVID-19 pandemic and resulted in more than $143 million in false billings.

Then this past September, the department announced criminal charges against 138 defendants, including 42 doctors, nurses and other licensed medical professionals, for alleged participation in fraud schemes that resulted in about $1.4 billion in losses.

“We have seen all too often criminals who engage in health care fraud stealing from taxpayers while jeopardizing the health of Medicare and Medicaid beneficiaries,” said Gary Cantrell, deputy inspector general for investigations with the Department of Health and Human Services Office of Investigator General, in a release.

“Every dollar saved is critical to the sustainability of our Medicare programs and meeting the needs of seniors and people with disabilities,” added Chiquita Brooks-LaSure, administrator at the Centers for Medicare & Medicaid Services, in the release.

CMS recommends consumers read their Medicare statements for accuracy and costs for treatment and care.

CMS also reminds consumers not share their Medicare number or other personal information with anyone who contacts them by phone, email or by approaching them in person, unless they have given them permission in advance.

Medicare or a Medicare plan representatives will call and ask for personal information only if you are already a member of the plan or if you have called and left a message or been told by a representative that someone would call you back.

CMS advises that consumers only give personal information to doctors, insurance companies or plans acting on your behalf, or trusted people in the community who work with Medicare, such as representatives with the North Dakota State Health Insurance Counseling Program.

If you join a Medicare plan, the plan will let you know how it will use your personal information. Be familiar with your plan’s policy.

Medicare uses personal information in limited situations, such as to work with providers on claims, work with declared personal representatives, or cooperate with law enforcement, fraud investigations or other government oversight activities.

If an unsolicited caller asks for your Medicare number or other personal information, hang up and call 1-800-MEDICARE or TTY 877-486-2048.

Lost or stolen Medicare cards should be reported to 1-800-MEDICARE for replacement using a Medicare Beneficiary Identifier instead of Social Security number.

Additional ways to protect yourself can be found online at medicare.gov by clicking on “forms, help & other resources” found in the Site Resources section at the bottom of the home page. Resources also are available from the Department of Health and Human Services Office of the Inspector General at https://oig.hhs.gov/fraud/consumer-alerts/.