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Last updated July 5, 2024

Senior LinkAge Line staff and volunteers must use the health care fraud form to report all Medicare and Medical Assistance related fraud, waste, abuse and scams. Reporting each of these issues is a federally mandated Senior Medicare Patrol (SMP) grant activity. If you receive a call about a person reporting a Medicare or Medical Assistance fraud, waste, abuse, or scam, it must be reported to the federal SMP program for follow-up and investigation. 

 

 Examples of fraud, waste, abuse and scams: 

Procedure: 

  1.  Visit the Fraud and scams Quick Reference for guidance on how to help the person.
  2. If a referral to another agency is appropriate, provide the referral information and then still proceed with the actions below, if necessary. 
    • For example, if the complaint is about an insurance agent, the health care fraud form should be completed and a call to the MN Department of Commerce should be made. 
  3. Document the call in the CTS.
    • Select Fraud and Abuse topic from the best option of either Cost Plan, Medicare Advantage, Medicare Part D, Medigap and Medicare Select, Original Medicare Part A and B, or Medical Assistance from the topics table.
  4. In the case within CTS, select the health care fraud form from the Microsoft Word templates.
    • The client and contact will already be filled in.
    • Complete it with as much information as is available, including the case number.
    • Upload the form to the case and record in a note that the form was sent for the person to complete, sign, date, and mail back.
    • To ensure that personal information is not stored on your computer desktop, delete the form once all actions are taken.
  5. Mail the form to the person and include a return envelope addressed to your Senior LinkAge Line office.
  6. When the form is returned, scan the form and attach a copy to the CTS timeline.
  7. Create a CTS task titled "Fraud form" and assign to Kelli Jo Greiner, complete all steps in case except for resolving.
  8. The Senior Linkage Line team will enter the form information into the federal reporting system and resolve the case within two business days. In most situations, the Senior LinkAge Line staff will not receive a case update due to the confidentiality of the case as well as the federal investigation that may take place. 

 Helpful links: 

  • SMP: Talking points for preventing, detecting and reporting Medicare fraud
 
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