Last year, Jean Bound received a package with COVID tests that she hadn’t ordered. She called the company whose name was on the packing list to say she hadn’t ordered them. In response, she was told not to worry, because Medicare had been billed and would be taking care of the cost.
She immediately contacted Medicare to report that she hadn’t ordered the tests. A couple of months later, she again received COVID tests that she hadn’t asked for. She called Medicare to report the fraud a second time but never received any confirmation that the situation had been resolved.
Later, when she received an explanation of benefits, she saw the charges on her Medicare statement.
“Medicare scammers send emails, make calls and create fake websites to trick you into giving them your personal Medicare and Social Security information,” says Ari Parker, co-founder and head of Medicare Advisory at Chapter, an independent company that offers free Medicare advice from licensed independent Medicare advisors.
And now is the time to be on alert, as Medicare fraud is more common during the annual Medicare enrollment period (October 15 — December 7), a window in which you can change your Medicare Advantage plan or drug coverage.
What Is a Medicare Scam?
According to the Social Security Administration, Medicare fraud costs Americans an estimated $60 billion a year.
A Medicare scam occurs when a provider, a supplier or an individual poses as you to receive medical care, services, supplies or prescription medications and uses your personal information — your name, Social Security number, Medicare number – without your consent, to submit false Medicare claims.
Beware of criminals pretending to be from Medicare or other known organizations trying to trick you into giving them your information. It’s one of the most rampant kinds of frauds in the country and is a serious crime.
[READ: How Do You Apply for Medicare?]
Common Medicare Scams
Medicare scams are common and come in many different and ever-evolving forms. A good rule of thumb to combat all of them is to never give your personal information to anyone unless you are completely certain of who they are. Guard your Medicare and Social Security information the same way you would guard your credit cards.
Here are some of the current common Medicare scams:
— Medicare Enrollment Center fraud: Calls from people saying they’re from your Medicare Enrollment Center. These callers will ask about your coverage, may say they’re doing surveys and will do their best to get you to give them your Medicare information.
— Medicare card information fraud: Calls from people who say your card has expired and they need your Medicare information to get you a new one. Many will say you need a new card with a chip or that you need a laminated card. Medicare cards come in paper form only.
— Medicare plan switching fraud: Calls from people who say you need to switch Medicare plans or you’ll lose coverage. Callers will ask for your personal information to help you do that.
— Medicare bargain and perk fraud: Calls from people offering rebates, refunds, cheaper plans and better deals and saying they need your Medicare information to ensure you get these perks.
— Medicare free supplies and testing trial fraud: Calls from people who say they’re from companies offering free medical supplies or testing trial offers and will want your Medicare information before you get these services.
— Medicare genetic testing fraud: A company will offer you “free” or “at no cost to you” genetic tests, such as cancer screening tests or dementia screening tests, without a physician’s order and will bill Medicare for the cost. Fraudsters will request your Medicare information at health fairs, senior centers, church-sponsored events and other venues.
— Medicare health fair fraud: At health care fairs, fraudsters will set up stands offering raffles and free gifts that require your Medicare information for entry.
— Medicare phony organization fraud: Calls from people saying they’re from your doctor’s office or a state or local agency and requesting information.
— Medicare low-cost plan fraud: Calls or visits from people who say once you give them your Medicare information, they can offer you a plan that is less expensive.
— Medicare free health consultation fraud: Calls from people who say that once you give them your Medicare information, they will give you access to free health consultations.
— Medicare telemedicine fraud: Calls from people who begin to talk about your health and then bill Medicare for telehealth services.
— Medicare supplies fraud: Calls from people who ask you to ask your doctors for supplies and equipment you don’t need or for items like back braces, wheelchairs, electric scooters and other equipment or who will have equipment delivered when it’s not needed and bill it to Medicare.
— Medicare threatening to withhold services fraud: Calls from people posing as Medicare agents who pressure you to buy high-priced medical services and diagnostic tests or threaten to withhold services if you don’t provide your information.
— Medicare home health care services fraud: Someone who got a hold of your information may bill Medicare for home health services you don’t need and never asked for.
— Medicare threats to cancel coverage fraud: Calls from people saying there’s been fraudulent activity or a problem with your Medicare account. They may tell you that benefits will be canceled unless you immediately verify your personal information.
— Medicare owes you a refund fraud: Calls or a notice that you are eligible for a Medicare refund due to changes in your plan and should give out your information before you can obtain a refund.
— Medicare hospice fraud: Scammers get beneficiaries to agree to hospice care even though they don’t qualify for it. They then bill Medicare for that care.
[READ: Medicare Mistakes to Avoid.]
Common Medicare Scams by Health Care Providers
Most health care providers are doing their best and practicing medicine honestly and in good faith. However, there are some who also are scamming the Medicare system.
Here are some common ways health care providers defraud Medicare using your information.
— Double billing: Submitting multiple claims for the same service
— Phantom billing: Submitting bills for a visit that never took place
— Upcoding: Billing for a more expensive service than a patient received
— Performing medically unnecessary services: Some providers do this to generate more Medicare reimbursement payments
— Misrepresenting noncovered treatments: Submitting treatments that aren’t medically necessary, like cosmetic surgeries, to Medicare for payment
— Falsifying patient records: Falsifying a patient’s medical records to justify additional tests, surgeries and procedures that aren’t medically necessary
— Unbundling: Billing for each step of a procedure as if they were all separate procedures to be paid higher fees
— Billing Medicare more than the required co-payment: Billing for services that were paid in full by a patient’s benefit plan
— Kickbacks: Offering money for patient referrals
[Related:HSA and Medicare: Using HSA To Pay for Medicare Premiums]
Risks and Consequences of Medicare Fraud
Medically unnecessary products and services that end up on your records could later result in improper medical treatment from legitimate providers, according to Nicole Liebau, a center director advisor at Senior Medicare Patrol. SMP is a group of volunteer-based organizations funded by the U.S. Department of Health and Human Services to educate Medicare beneficiaries on how to prevent, detect and report Medicare errors and abuse.
“Because of inaccurate or fraudulent claims to Medicare, you may be denied needed medical benefits,” Liebau explains. “Some services have limits, and if Medicare thinks such services have already been provided, they will deny payment.”
Inaccurate medical records could contain the following:
— False diagnoses
— Records showing treatments that never occurred
— Misinformation about allergies
— Incorrect lab results
What’s more, Medicare fraud, errors and abuse can result in higher out-of-pocket costs for beneficiaries.
Medicare Education to Prevent Fraud
Because Medicare is complicated, it’s important to learn what your coverage includes, how Medicare uses your personal information, what your rights are and which services providers can and can’t bill to Medicare.
“Educating yourself on how to spot red flags of potential fraud is the best way to prevent and detect Medicare fraud,” Liebau says.
Here are some of the ways you can educate yourself to prevent Medicare fraud:
— Learn how to read your Medicare statements. They show the services, supplies or equipment you received, what you were charged and how much Medicare paid. SMP provides information to help you do that.
— Use tools to help you detect Medicare fraud. You can and should track your medical appointments and services. SMP can help with a tool called My Health Care Tracker.
Lower Your Risk of Medicare Fraud
Medicare fraud is sometimes hard to detect. Criminals can be very sophisticated in their schemes and fraudulent activities. Here are some things to watch for so you don’t become a victim:
— Check Medicare or Medicare Advantage statements. Check your statements to ensure you have received the services Medicare or Medicare Advantage has paid for.
— Don’t give out your personal information. Never give your information to anyone who contacts you, even if it looks to be Medicare. Medicare will never call you unless you have specifically asked them to do that, and they don’t call to sell services or insurance products. As soon as someone asks for your personal information by mail, social media or text, or someone shows up at your door, it’s a scam.
— Watch out for phishing. Don’t click on email links, open attachments or call any number on messages. Scammers are likely phishing for personal information.
— Medicare phone calls. Don’t be tricked if someone says they’re calling from Medicare, even if the number looks official.
— Check statements from health care providers. Look at the statements you get from your health care providers for mistakes. Call them if you think something isn’t correct. Save receipts and statements from health care providers to compare with statements sent to you after claims have been processed.
— Protect your medical records. Don’t give anyone access to your medical records except the doctors and providers you know and trust.
— Hang up if you accidentally answer an official-looking call. Scammers have many ways of devising phone numbers to make them look official, but if you do answer a call and it isn’t who you thought it would be, hang up immediately.
— Check your prescriptions. Before leaving a pharmacy, make sure you’ve gotten the right medicine and the right amount.
How to Report Medicare Scams
Depending on your situation, there are actions you can take for potential Medicare scams:
— If you want to ask questions about potential fraud or error concerns, call the following Medicare fraud phone numbers: 1-800-MEDICARE (1-800-633-4227) or for TTY users, 1-877-486-2046.
— Report fraud to the Office of the Inspector General at the Department of Health and Human Services. They have a fraud hotline that can be reached at 1-800-HHS-TIPS (1-800-447-8477). TTY users, call 1-800-377-4950.
— If you have a Medicare Advantage plan or Medicare drug plan, you can call the Investigations Medicare Drug Integrity Contractor at 1-877-SAFERX (1-877-772-3379).
— The SMP Resource Center can help direct you to your local SMP if you call 1-877-808-2468. You can also report potential Medicare fraud, errors or abuse to the SMP online. Your local SMP can assist with appropriate referrals to state or federal agencies.
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