Everence cares about your well-being, so we’d like to pass along some tools you can use to protect yourself and those you love from opportunistic Medicare scammers.
Medicare designates one week annually to raise awareness of the actions you can take to prevent Medicare fraud, errors and abuse. Medicare Fraud Prevention Week is recognized in June, during which Social Security and the Senior Medicare Patrol team up to provide best practices, stories and resources to help you learn how to detect, prevent and report fraud.
Medicare loses approximately $60 billion (about $180 per person in the U.S.) each year due to fraud, errors and abuse. This results in higher health care costs and taxes for everyone. Not only does fraud have a monetary impact, but it can also take an emotional toll on victims and their loved ones.
What are some of the most common Medicare-related schemes and scams happening now? We’ve pulled together a list so you can stay alert and watch out for potential issue.
- Durable Medical Equipment Provider Scam: In a recent scheme identified in a consumer alert from the U.S. Department of Health and Human Services Office of the Inspector General, it was highlighted that scammers are using enrollees’ personal information to submit monthly bills to Medicare for medically unnecessary urinary catheters that may or may not actually be sent to the Medicare enrollee. In this example, the bogus durable medical equipment company’s goal is to obtain the enrollee’s Medicare number
Durable medical equipment scams tend to be a favorite of health care fraudsters; we’ve seen scams involving knee and back braces, diabetic supplies, and more! The scammers rely on kickbacks to unethical medical professionals, telemedicine staff and telemarketers who partner to mislead seniors into providing their personal information and Medicare numbers. The scammers then use their ill-gained information to submit false claims for reimbursement to the federal Medicare program.
- COVID Fraud: This scam has been going on since the height of the COVID-19 pandemic. Fraudsters offer free coronavirus tests as a means of collecting people’s Medicare numbers and personal information and then fill a counterfeit claim in their name to Medicare.
- Fake Genetic Testing and/or Telemedicine Scam: Medicare rarely covers genetic testing; however, scammers will use this scheme as a tactic to obtain a person’s Medicare number so they can apply false charges to Medicare. This can happen by someone calling you and offering a free genetic test. Once the scammer gets your Medicare number, they may also bill Medicare for a bogus telemedicine appointment.
- Upgraded Medicare Card Scheme: There have been reports of people receiving phone calls from individuals posing as Medicare representatives offering upgraded, hard plastic Medicare cards with a chip in them. The scammer asks for payment and your Medicare number.
- Hospice Fraud: Some scammers partner with dishonest healthcare practitioners who “diagnose” otherwise healthy individuals as terminally ill and on hospice. The scammer is then able to send paperwork through to Medicare claiming thousands of dollars of Medicare payments for the erroneous hospice services.
…unfortunately, the list continues.
None of us want to fall victim to scams or see loved ones in a position where they are vulnerable, especially when there are some very simple tips and/or steps to take to avoid Medicare-related scams. Let’s look at some of these best practices:
- Medicare will not call you… unless you have previously called them and have scheduled an appointment with a Medicare representative.
- Treat your Medicare card like a credit card. Don’t share your Medicare number, Social Security number or any of your personal information with a person contacting you over the phone, via email or in person unless they are a professional that you know and trust.
- Record appointments and services. Keep a calendar or planner with notations of health care appointments and treatments. This will provide you with a ready resource to double-check if you are suspicious of a provider bill or a charge listed on an explanation of benefits document.
Pay attention to your Medicare Summary Notices and your Everence Explanations of Benefits. These notices include a breakdown of the health care services, supplies or equipment you received, what you were charged, and how much Medicare and Everence paid. Review each notice for accuracy and to make sure that you, Medicare and/or Everence weren’t billed for anything you didn’t receive. Most often, we are made aware of new Medicare schemes through vigilant Everence members who thoroughly review their MSNs and EOBs.
- Be suspicious of doctors, health care providers or suppliers that tell you…
- The equipment or service is free, and they only need your Medicare number for their records.
- Medicare wants you to have a certain item or service.
- They “know” how to get Medicare to pay for the specified item or service.
- The more tests they provide, the cheaper the tests become.
- Don’t accept deliveries you didn’t order. If medical equipment, supplies or at-home tests are delivered to you, do not accept them unless they were ordered by your personal physician. You can refuse the delivery or return it to the sender. You will want to keep a record of the sender’s name and the date that you returned the items.
- Don’t take advice or offers of medical services… from unknown callers, people who come to your door, or those who might approach you in public.
If you do happen to see an unfamiliar provider name or service listed on a Medicare Summary Notice or feel like you may be a victim of a Medicare-related scam, you can:
- Call your health care provider directly to inquire about the service/charge.
- Call Medicare at 1-800-MEDICARE.
- Call the fraud hotline of the U.S. Department of Health and Human Services Office of the Inspector General at 1-800-HHS-TIPS.
- Contact your local Everence representative to report the fraudulent provider/charge.
Sometimes when you report fraudulent activity to Medicare, they will issue you a new Medicare card. If that happens, make sure to share the new card with your health care providers and Everence to ensure your health care claims are processed correctly on your behalf.
Unfortunately, the “game” is always changing with these schemes. It’s so important to trust your gut and follow your instincts. If something doesn’t feel right, or you are feeling pressured – it is probably a scam. Don’t be embarrassed or afraid! Let a family member, loved one or trusted professional (like your local Everence representative) know about the situation. They can help you make a report to the proper authorities. Together, we can make the game harder for the swindlers to win!