Rights and Protections

Rights & Protections

No matter which plan you have, you have important rights in Medicare. Compared to most private health insurance, Medicare has some of the best consumer protections. Learn more in Your Medicare Rights and Protections, an official guide from the U.S. government. This booklet has important information about:

  • Your right to file a complaint
  • Your right to get health care services that you need
  • Where you can get help with your questions

Fraud and Abuse

Fraud typically occurs when Medicare is billed for treatments or other services (including supplies) never received by you, the patient. It is estimated that Medicare fraud costs Medicare millions each year.

Abuse typically occurs when healthcare providers fail to follow established medical practices. This failure can result in wasteful costs to Medicare, improper payments, or unneccessary and potentially harmful medical services. (Learn more)

CLAIM works with the SMP Program, which can help if you suspect you’ve been a target of Medicare errors, fraud, or abuse. Missouri’s SMP is run by Care Connection for Aging Services. To report errors, fraud and abuse:

  • Call your plan provider. Discuss any questions you have and try to work out your concerns.
  • If you uncomfortable calling your provider or unsatisfied with the response, your SMP can be reached at 1-888-515-6565. You can also reach Care Connection for Aging Services directly by email at information@GoAging.org.

Discharge Appeals

If you believe you are being discharged too quickly from a hospital, you can request that the decision be reviewed by the state’s Medicare Quality Improvement Organization. In Missouri, KEPRO provides this discharge appeals service. If you wish to make an appeal, call KEPRO toll-free at (855)408-8557.

Quality of Care Concerns

If you are troubled by the quality of a Medicare service, call 1-800-Medicare (1-800-633-4227). In Missouri, you will be directed to call KEPRO. Experts at KEPRO will review your medical recordsto determine if your care met professional standards.

Examples of quality of care concerns you might report are:

  • Being given the wrong medication, or a medication to which you are allergic, or medications that interact in a negative way.
  • Not receiving treatment after abnormal test results.
  • Being given the wrong blood when a transfusion is ordered.
  • Sustaining a serious injury resulting from a fall while in a nursing home or hospital.
  • Being improperly evaluated for a problem and because of this you did not receive the treatment you needed.
  • Being given the wrong treatment or treatment that you did not need.
  • Developing bed sores because you were not moved regularly.