Question; I received an Medicare Summary Notice with COVID tests ordered, but I didn’t order them, and I didn’t get them. What should I do?

Answer: Whenever you go to see your doctor or are admitted to the hospital, your benefits are processed through your insurance provider. The insurance carrier will either mail you a Summary Notice or an Explanation of Benefits notice.

Traditional Medicare recipients receive a Medicare Summary Notice (MSN). This notice alerts you to the fact that a provider has billed Medicare using your ID number for a service or office visit. You have heard me ask many times that Medicare enrollees review these notices to be sure the physician’s name, the date of service and procedures were accurate and something they had done.

MSNs are mailed out by Centers for Medicare & Medicaid Services (CMS) on a quarterly (04-01 to 06-30) schedule for both Part A (Hospital Insurance) and Part B (Medical Insurance).

These MSN may not list the claims in chronological order. Claim information includes the doctor name, participating group or clinic, a Claim number (the number given to this individual claim), the address of the individual billing Medicare and the service date of the claim. Often there are two or three items listed. For example, it will list a date, 04/23/23, one listing for an office visit, one listing for additional things that were done. This would be where you saw the COVID tests and the date they were ordered. Sometimes our providers order items and tests that we don’t realize are billed separately. In this situation you saw the COVID tests and realized you didn’t get them and may not have asked for them.

This type of Medicare Fraud is unfortunately more common than you would imagine. During the Public Health Emergency (PHE) we have talked about in past columns, each household could get up to 8 over the counter COVID tests free for those with Medicare. This coverage seemed to be a flood gate for Fraud. In some situations, I found individuals who were shipped tests they didn’t order. That means Medicare was billed even though you didn’t want or get the tests. The price was inflated, and the fraudsters made money.

Your nonexistent COVID test “ordered and paid for”, but never received is another type of Fraud. In your situation you didn’t want them, and you didn’t get them, that is truly Medicare Fraud and should be reported.

One of the ways to report this Fraud is directly to Medicare at

1-800-MEDICARE (800-633-4227). CMS is working hard to prevent fraud and working to prosecute those that execute these types of fraud. You can help them by reporting this situation.

You can also reach out to the New York StateWide Senior Action Council, Inc and their Senior Medicare Patrol Department at 1-800-333-4374. The program works to educate and assist those on Medicare with Fraud related issues. The agency collects data regarding these types of situations, researches the claim and then compiles the cases and reports it to CMS as well.

If you have a Medicare Advantage Plan your notice would come from your provider as an Explanation of Benefits (EOB). In this case, you would NOT receive a Medicare Summary Notice (MSN) because your claims are NOT processed through the Medicare insurance system. The EOB you receive would come on your insurance carrier’s letterhead with their explanation of coverage. The information provided will be very similar but may have a different layout. When you have a Medicare Advantage Plan, and you have questions you should call your insurance company directly. You could also find a situation where this could happen, but it is not as common because Medicare Advantage Plans have a much tighter control of coverage and benefits provided to their enrollees.

Janell Sluga is a Geriatric Care Manager helping seniors in our community access services and insurance. To reach her, please email editorial@post-journal.com.