Problems and Inefficiencies With Medicare Claims and Errors

Part 3, Chapter 9: Medicare and Medicare Related Programs: Medicare Page 11

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As a result, even widows or widowers who are retired and who have been covered by Medicare for years may find that their claims are suddenly rejected. In some cases, Medicare may insist that it does not represent the individual's primary carrier because the person's spouse -- who may, in fact, have died many years before -- is covered by an employer-sponsored group health insurance program, or because the individual is working on a full-time basis, or is no longer eligible for Medicare benefits.

Unfortunately, writing to Medicare and explaining the actual situation does not always seem to lead to a successful resolution of the problem. Although it would be simple for Medicare to establish a single national toll-free number for beneficiaries to call in order to quickly correct errors of this type, such a system has not yet been established.

Developing a more efficient system for dealing with fraud, billing errors, and overpayments would also save a significant amount of money. Over the years, Medicare has instituted a variety of mechanisms to prevent and deal with such problems.

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