ulikins
New
We have a situation where our Health Plan member is a commercial member. There is another individual (not insured under our Health Plan) with the same name and birthdate who has Medicare coverage. The individual’s Medicare file has our commercial member’s plan as the individual’s secondary/supplemental insurance, therefore when the individual has services the claims cross over to our member. Our member and the individual have reported this to Medicare, and it has not been cleared up. Our commercial member keeps calling us because of potential fraud. Does anybody have any suggestion on how to solve this with Medicare?