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Medicare & Medicaid News

New Medicare Statements in the Mail to Help Seniors Fight Fraud

Redesigned health care summaries designed to help seniors identify improper payments; mailed quarterly

June 10, 2013 – Medicare says senior citizens and other beneficiaries of the program will soon be receiving a redesigned statement of their claims for service and benefits. The new look is aimed at helping them spot “potential fraud, waste and abuse.”

The notice posted online by the Centers for Medicare and Medicaid Services says the “newly redesigned Medicare Summary Notices are just one more way the Obama Administration is making the elimination of fraud, waste and abuse in health care a top priority. Because of actions like these and new tools under the Affordable Care Act, the number of suspect providers and suppliers thrown out of the Medicare program has more than doubled in 35 states.”

“The new Medicare Summary Notice gives seniors and people with disabilities accurate information on the services they receive in a simpler, clearer way,” CMS Administrator Marilyn Tavenner is quoted as saying. “

CMS says, “It’s an important tool for staying informed on benefits, and for spotting potential Medicare fraud by making the claims history easier to review.


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“The redesigned notice will make it easier for people with Medicare to understand their benefits, file an appeal if a claim is denied, and spot claims for services they never received.”

CMS plans to send the notices to Medicare beneficiaries on a quarterly basis.

“A beneficiary’s best defense against fraud is to check their Medicare Summary Notices for accuracy and to diligently protect their health information for privacy,” said Peter Budetti, CMS deputy administrator for program integrity. “Most Medicare providers are honest and work hard to provide services to beneficiaries. Unfortunately, there are some people trying to exploit the Medicare system.”

The agency statement says, “Medicare beneficiaries and caregivers are critical partners in the fight against fraud. In April of this year, CMS announced a proposed rule that would increase rewards— up to $9.9 million – paid to Medicare beneficiaries and others whose tips about suspected fraud lead to the successful recovery of funds.”

CMS’ Update on Anti-Fraud Efforts:

The Affordable Care Act has enabled CMS to expand efforts to prevent and fight fraud, waste and abuse.

   ● Over the last four years, the Obama administration has recovered over $14.9 billion in healthcare fraud judgments, settlements, and administrative impositions, including record recoveries in 2011 and 2012.

   ● Since the Affordable Care Act, CMS has revoked 14,663 providers and suppliers’ ability to bill in the Medicare program since March 2011 (Chart 1). These providers were removed from the program because they had felony convictions, were not operational at the address CMS had on file, or were not in compliance with CMS rules.

   ● In 18 states, the number of revocations has quadrupled since CMS put the Affordable Care Act screening and review requirements in place, as well as the implementation of proactive data analysis to identify potential license discrepancies of enrolled individuals and entities. These efforts are ensuring that only qualified and legitimate providers and suppliers can provide health care products and services to Medicare beneficiaries (Chart 2).

Chart 1

Chart 2 

For more information about the Medicare Summary Notice, visit:


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