Provider Education


Everyone pays the price for health care fraud, errors and abuse, through higher insurance premiums, increased costs for medical services and equipment, and greater expenditures for Medicare and Medicaid.

Criminals specializing in defrauding and abusing Medicare and Medicaid have invaded healthcare and healthcare-related fields across the country. Medicare fraud is appealing to career criminals because it is a white collar crime; it is less dangerous and carries lighter penalties.

Scam artists on an average relocate every 90 days. Why South Dakotan’s are targets for health care fraud and identity theft:
  • We are generally honest and trusting people.
  • 80% of scams are targeted at people age 60 and over.
  • 16% of South Dakota's population receives Medicare.
  • 18% of South Dakota's citizens are over the age of 65.
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How can I protect my professional identity, reputation and business records?

You can minimize your risk by managing your information wisely and with heightened sensitivity.

Protect Your Identity

Provider Numbers are being:
  • Sold on the black market for $50 or more.
  • Obtained from the internet.
  • Obtained from obituaries – criminals watch for deceased providers and ask for duplicate records.
Once someone has your provider number and identity, they may:
  • File claims under your name using Medicare numbers they have purchased from seniors, making you look guilty of fraud.
  • Divert your mail to another location by completing a change of address form. Allowing them to receive payments from Medicare and other insurance companies mailed to this P.O. box. Once they receive the payments they are deposited into a commercial bank.
Protect Your Records

Criminals pay to have people sort through your garbage looking for billing information that has been discarded. They are looking for:
  • Patient personal information along with their Medicare and insurance numbers.
  • Provider numbers of the physicians and others in the office.
  • Billing forms and codes.
Criminals can use this information to bill Medicare for services that never took place using your provider number.

To avoid falling victim to this type of fraud shred all paperwork that contains your personal information as well as your patients before throwing it away. Also make sure your charts and files are locked or stored where there is limited access.

Protect Your Work Areas

Know who has access to your computers.
  • Use Password protection.
  • Require employees to log off at the end of their shift.
  • Do not allow employees to place their passwords where anyone else may see them.
Be mindful of the traffic flow in your office.
  • Can someone standing in line hear or see confidential information?
  • Do your monitors face the public?
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How does the South Dakota SMP help providers?

We encourage people on Medicare to be responsible for their health care and records. Using trained volunteers who teach people on Medicare to:
  • Rely on their physician to recommend medical services or equipment.
  • Read their Medicare Summary Notices and statements. If they have questions or need clarification we encourage them to:
    • Call the provider. If a mistake has occurred they will make the correction and refund Medicare if necessary.
    • Call the secondary insurance carrier; refund their co-insurance payment if necessary.
    • If they are overwhelmed or confused instruct them to call South Dakota SMP and request a volunteer.
  • Spot scams, which erode the Medicare system and tarnish your reputations.
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