Data from industry sources cite Medicare fraud against consumers as the “largest type of insurance fraud,” with tens of billions of dollars lost each year by consumers.
With Medicare open enrollment season rolling along, it’s a good idea for enrollees to recognize and take action to stop Medicare fraud against them in its tracks.
Just how bad is the Medicare consumer fraud problem? According to the Coalition Against Insurance Fraud, Medicare fraud — against consumers, government, and private health insurers — is the “largest type of insurance fraud by far.”
Medical practitioners say they see Medicare fraud on a regular basis — and note the problem is growing worse.
“I’m a chiropractor practicing in South Carolina and I actually stopped accepting Medicare patients who want their insurance filed last year,” says Nicole Dearing, owner of Vitality Chiropractic, in Gaffney, South Carolina.
Dearing says that one of the main reasons she started turning patients away was due to fraud.
“I’ve had patients come to see me tell me that other chiropractors have charged them thousands for care when in fact their insurance would cover at least a portion of their care,” she notes. “I’ve also had other patients tell me their deductibles were met by paying only a portion of what the deductible truly was and asked if I could do the same.”
Forms of Medicare fraud
There are other ways that Medicare enrollees can be victimized by fraud. These three scams are at the top of that list:
Via phone — Identity fraudsters often target older Medicare enrollees via a phone call, telling seniors they’re with the government or a doctor’s office, and try to steal Medicare account data which they later use to commit fraud.
Via email — Medicare fraud artists also frequently use email “phishing” techniques to reach out to Medicare enrollees, again claiming to be from the government or from a local hospital or doctor’s office. The scammers often try to elicit a Medicare enrollee’s personal data through email directly, claiming they need the user’s personal data to complete some important paperwork, and ask the Medicare beneficiary’s Social Security number, and/or bank account and credit card account information. Or, they’ll attempt to get a senior to click on a malware-loaded email link, which then steals the consumer’s data .
Via Medicare card theft — As Uncle Sam rolls out its massive Medicare identification program to all of the nation’s 58 million Medicare enrollees, scammers are already busy trying to steal valuable card data. According to AARP, fraud artists “pose as Medicare representatives and contact beneficiaries to demand immediate payment via credit card of a processing fee for the new card – but no such fee exists.” Or, scammers “falsely say that Medicare needs to “verify” a recipient’s Social Security number or other personal information before issuing the card,” AARP reports. “Yet Medicare says it does not make such calls and does not initiate uninvited contact.”
Actions to protect against Medicare fraud
The good news? Medicare enrollees can take direct action to mitigate or even eliminate Medicare fraud, experts say.
Get started with these five tips:
- Lock down your medical information. “Be suspicious if anyone other than your doctor or medical provider asks for your information, especially because this includes your Social Security number,” says Diana Golub, a licensed medical professional and director of options at AIA Direct, in Bradenton, Fla. “Make sure you protect your Medicare card and don't share your Medicare number. Think of it like a credit or debit card number. Be aware of online or phone scammers. You don’t have to pay a processing fee or purchase a temporary card should you misplace your Medicare card.”
- Review your Medicare claims. Review your Medicare claims to make sure there aren’t any errors or suspicious activity, advises Justin Lavelle, chief communications officer at BeenVerified, an online background check platform. “Each time you receive health care services, write the service date on your calendar and save all the statements or receipts you may get back from your providers,” Lavelle says. “Check them for errors by comparing your health care service dates – as listed on your calendar – with what is listed on your statements.” In addition, check to ensure the prescriptions you’ve filled match the ones listed on your statements. If you find any errors, call 1-800-MEDICARE, Lavelle says.
- Educate yourself on the new Medicare cards. The new cards, which are being mailed out between April, 2018 and April 2019, need to be thoroughly examined. “The new cards will display a Medicare number that is unique to each client rather than the previous display of one’s social security number,” Lavelle says. “A scam artist may contact you regarding your new card and attempt to get your personal information such as your Medicare number.” Know that Medicare will never contact you first and request that you provide your personal information before they can send you your new Medicare card, Lavelle notes. “If someone calls claiming to be representing Medicare and asks you to pay money or says your benefits will be cancelled if you don’t provide them with your personal information, call 1-800-MEDICARE,” he advises.
- Don’t accept any services that you don’t need. If your provider is putting pressure on you to get health care services you feel you don’t need, you can refuse the care and request another physician give you a second opinion. “Don’t feel that because it is your physician, someone you’ve trusted in the past, that you must move forward with all of their healthcare recommendations,” says Lavelle. “Medical professionals falsely billing Medicare, advising procedures with higher rates of payment, and filing false claims has been on the rise in the last decade.”
- Be careful with all physician interactions. On its fraud prevention web page, Medicare.gov advises Medicare enrollees to not allow anyone, except your doctor or other Medicare providers, to review your medical records or recommend services. “Also, don't contact your doctor to request a service that you don't need and don't let anyone persuade you to see a doctor for care or services you don't need,” the agency states.
One last point on Medicare fraud — it does cut both ways
“Fraud, abuse, waste and error all can go both ways in both Medicare and Medicaid,” says Dr. Deane Waldman, director at the Center for Health Care Policy, Texas Public Policy Foundation.
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“Providers obtain inappropriate payments from third-party payers, and consumers garner coverage, paid by the government, to which they are not entitled,” Waldman notes. “The one-step solution is to get the third party out of the equation — reconnect buyer and seller,” he adds. “That is the way every other market for every other good or service works.
Editor's note: If you believe that you’ve been victimized by Medicare fraud, take these action steps:
- Call CMS at 1-800-MEDICARE (1-800-633-4227).
- Report it online to the Department of Health and Human Services Office of the Inspector General.
- Call the Office of the Inspector General at 1‑800‑HHS‑TIPS (1‑800‑447‑8477) or TTY: 1‑800‑377‑4950.
- Call your state insurance department or local law enforcement.