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The Role of Medicare Representatives

As a participant in a health and/or drug plan underwritten or administered by CommunityCare, there are a number of things you can do to help identify and prevent health care fraud. You should, however, first be aware of certain guidelines concerning Medicare and the unique role it plays with respect to fraud, waste and abuse. Individuals working for or with Medicare are not permitted to:

  • Come to your home uninvited to sell or endorse any Medicare related product
  • Enroll you into a prescription drug plan over the telephone, unless you initiate the call
  • Ask for bank account or other personal information over the phone
  • Ask for payments over the phone or Internet
  • Seek premium payments up front or before you have been billed
  • Call a beneficiary after he/she has asked not to receive additional calls
  • Call before 8 a.m. or after 9 p.m.
  • Offer a gift worth more than $15 or a cash payment as an incentive to enroll in a plan

With these guidelines in mind, here are some of the more common fraudulent schemes and other practices that may give rise to fraud, waste or abuse:

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