When health care fraud means Medicare gets billed for help people never receive

Medicare scams are on the rise, and Senior Medicare Patrol offices in D.C. and every state are working to fight fraud. There are ways Medicare recipients can help that effort and help themselves.

It’s estimated about $60 billion taxpayer dollars a year is lost to Medicare fraud, errors and abuse, and while that might sound implausible, “in calendar year 2020, the Medicare program is estimated to have spent $861.9 billion to provide health care services for approximately 63 million elderly and disabled beneficiaries,” according to the U.S. Government Accountability Office.

“Our goal is to try to keep people from becoming victims of Medicare fraud in the first place,” said Rebecca Kinney, director of the Office of Healthcare Information and Counseling for the Administration for Community Living, which is a division under the Department of Health and Human Services. “But we also provide assistance if someone thinks they may have been a victim; our program can help them navigate that and determine — is it really fraud, or was it a mistake?”



There are numbers of different scams.

One, for example, involves scammers convincing people they might be at risk of cancer and need a genetic test to look for genetic markers for cancer.

“In reality, most people don’t need those cancer genetic screening tests. But to the fraudster, those tests can be worth tens of thousands of dollars,” Kinney said.

In some cases, the testing is performed, but it’s not necessarily what gets billed to Medicare. There are lots of cases where scammers just steal the Medicare information from someone, so they can bill Medicare and never deliver what’s promised.

“That’s the actually the biggest piece of fraud — is billing for things like those genetic tests or wheelchairs or back braces, diabetic supplies that people never receive,” Kinney said.

So what can the average person do?

Never share your Medicare number: “Guard that card; don’t give out your number,” Kinney said.

Be diligent about checking statements: “Unless you’re looking at your statement, you may not even know that Medicare was billed for those things that you didn’t get,” Kinney said.

If there’s something you need, work with your doctor: “In all of these cases, even the genetic testing, if it’s something you think you need, talk to your doctor. Your doctor knows you, knows your conditions, and knows what is appropriate for your health care,” she said. “Your doctor can get you connected to a legitimate provider to get you that item or service that you need in a legitimate way that’s not going to put you at risk for Medicare fraud.”

Don’t hesitate to reach out for help: Senior Medicare Patrol is a free national program.

“Medicare’s confusing. It’s really easy to get muddled up in it all when you’re trying to look at those statements. If you have questions, contact your local Senior Medicare Patrol. We will help you sort through it and help answer your questions and help you navigate that complication of Medicare,” Kinney said.

You can find contact information for your local Senior Medicare Patrol program online or call the toll free helpline at 877-808-2468.

Kristi King

Kristi King is a veteran reporter who has been working in the WTOP newsroom since 1990. She covers everything from breaking news to consumer concerns and the latest medical developments.

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