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Most doctors, pharmacists, and other health care providers who work with Medicare and Ultimate Health Plans are honest. Unfortunately, there may
be some who are dishonest. "Fraud" happens when Medicare or Ultimate Health Plans is billed for services or supplies you never got. "Abuse"
happens when doctors or suppliers don't follow good medical practices, which leads to unnecessary costs to the Medicare program, improper payment, or
services that aren't medically necessary. Fraud and Abuse waste Medicare dollars and take money that could be used to pay claims. Every day,
consumers get ripped off by scam artists. The Medicare program loses billions of dollars each year. You’re important in the fight to prevent fraud,
waste, and abuse in the Medicare Program. You can make a difference! Take an active role in protecting your health care benefits. What can you do?
Protect your personal information
Protecting your personal information is the best line of defense in the fight against health care fraud and abuse.
- Be sure to protect your membership card, as it contains information regarding your benefits. Report a lost or stolen membership card to Ultimate
Health Plans as soon as possible.
- Only allow appropriate medical professionals to review medical records or recommend services.
- Treat your Medicare, Medicaid and Social Security numbers like a credit card number. Never give these numbers to a stranger.
- Don’t carry your Ultimate Health Plans, Medicare or Medicaid card unless you will need it. Only take it to doctor’s appointments, visits to your
hospital or clinic or trips to the pharmacy.
- Save Notices and Part D Explanation of Benefits you receive from Ultimate Health Plans, but shred the documents when they are no longer useful.
- Never sign a blank form. Always read and keep a copy of any document or agreement you sign.
Beware of scams
- Avoid telephone or e-mail offers of "free" medical tests or supplies in exchange for a "peek" at your Member ID, Medicare or Medicaid card.
- Beware of advertising that promises your health plan or Medicare will pay for certain care or devices.
- If you rent medical equipment, such as a walker, return the item to the medical equipment dealer when you are finished. Always get a
dated receipt for the return.
- Beware of offers of TENS units (battery-powered units that send electrical impulses to reduce pain), nebulizers (breathing machines), noninvasive
blood flow studies, "free" cholesterol checks and promises of "stroke prevention." Rely on your own doctor’s advice to
prescribe appropriate treatment for you.
- Remember, Medicare doesn’t call or visit to sell you anything.
Check your statements for mistakes
When you get health care services, record the dates on a calendar and save the receipts and statements you get from providers to check for mistakes. If
you think you see an error or are billed for services you didn’t get, do the following to find out what was billed:
- Check your billing statements and any communication Ultimate Health Plans sends you to see if the service was billed to the plan.
- Look for three things on your billing statement:
- Charges for something you didn’t get
- Billing for the same thing twice
- Services that were not ordered by your doctor
- Ask questions – ask your provider or Ultimate Health Plans:
- WHEN…you don’t understand the charges billed
- WHEN…you don’t think you received the service
- WHEN…you feel the service was unnecessary
- If you know the health care provider or supplier, call and ask for an itemized statement. They should give this to you within 30 days.
- If you’ve contacted the provider and you suspect that Ultimate Health Plans or Medicare is being charged for a service or supply that
you didn’t get, or you don’t know the provider on the claim, call Member Services right away.
Watch Out for Medicare plans that don’t follow the rules
Most insurance agents who work with Medicare plans are honest, however a few aren’t. Know the rules Medicare Plans must follow when they try to
get you to join a plan. Make sure that you read and understand everything you sign to ensure that any changes are made only with your agreement and
permission. Medicare plans and people who work with Medicare aren’t allowed to do the following:
- Ask for your Social Security number, bank account number, or credit card information over the phone. (However, if you applied for Extra
Help paying for Medicare prescription drug coverage, someone from the plan may contact you if any information is missing from your application.)
- Come to your home uninvited to sell or endorse any Medicare related product.
- Offer you cash to join their plan or give you free meals while marketing to you.
- Enroll you in a drug plan over the phone unless you call them.
- Communicate incorrect information about their plan type or use inappropriate statements like their plan is "the best" or "highest ranked."
- Ask you for payment over the phone or Internet. The plan must send you a bill.
- Call you unless you’re already a member of the plan. If you’re a member, the agent who helped you join can call you.
- Sell you a non-health related product, like an annuity or life insurance policy, while trying to sell you a Medicare health or drug plan.
- Make an appointment to tell you about their plan unless you agree in writing or through a recorded phone discussion to learn more about the products
being discussed. During the appointment, they can only try to sell you the products you agreed to hear about.
- Talk to you about their plan in areas where you get health care, like an exam room, hospital patient room, or a pharmacy counter.
- Market their plans or enroll you during an educational event, like a health fair or conference.
How to report fraud
Even when you do everything right, there is a chance that you could be a target of healthcare fraud. The sooner you see and report errors, the
sooner we can stop fraud.
- Please contact our compliance team at 1-855-730-7925 and firstname.lastname@example.org or Investigatefwa@ulthp.com
- You can call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1 877 486 2048.
- You can also call the Medicare Drug Integrity Contractor (MEDIC) at 1-877-7SAFERX (1-877-772-3379). The MEDIC helps prevent inappropriate activity and fights fraud, waste, and abuse in Medicare Advantage (Part C) and Medicare Prescription Drug (Part D) Programs. Click on the button below to access their website:
- Download the form below to report fraud to Ultimate Health Plans.
The PDF documents can be downloaded and then viewed with Adobe Reader.
Want to find more information?
- Download CMS’s Publication: Protecting Medicare and You from Fraud. Read this booklet to learn how you can help and how you can protect yourself.
- You can also visit the following websites to find more information:
- Senior Medicare Patrol (SMP) Program educates and empowers people with Medicare to take an active role in detecting and
preventing health care fraud and abuse. Click on the button below to access their website:
- STOP Medicare Fraud is a complete source of information and a collaborative effort among the Department of Health and Human Services,
the Office of the Inspector General, CMS and the US Department of Justice. It provides many tools for people with Medicare, including ways
to report fraud. Click on the button below to access their website: