By M.E. Chidiac
December 1, 2019
“Hello, this is Medicare calling. Your coverage is about to be cancelled.”
This type of fraudulent call and others like it happen every day. According to AARP, Medicare fraud losses hit $60 billion in 2017 and continue to rise. And Medicare scammers seem to come out of the woodwork around the annual Open Enrollment period, which ends December 7.
The crooks are after your money or Medicare’s. They can use your information to file false claims, file “upcharge” claims for more expensive medical tests or equipment than the ones received, obtain pharmaceuticals to sell on the black market, sell your data to others on the dark web and even obtain treatment for themselves under your name.
What does all this mean to you or a loved one on Medicare?
If the Medicare health plan has annual caps on reimbursements for treatments or prescriptions, fraudulent claims may reach those caps, prohibiting a beneficiary from using actual benefits and disrupting the person’s medical care. And while most credit card companies only hold customers liable for $50 in the event of fraud, there’s no such leniency for medical identity theft. If Medicare suspects malicious activity with an account, the person with coverage could be held accountable and wind up spending thousands in legal fees to resolve the issue.
By knowing the Medicare scams to look for and what to do after a Medicare-related fraud, you can better protect yourself and loved ones. Here are some of the current Medicare scams:
Phone calls threatening to cancel Medicare coverage unless information is updated
It’s important to remember the first rule of thumb with Medicare: Unless you initiated the request, Medicare will NEVER call you.
These scammers may be very aggressive, calling numerous times, trying to wear you down.
One of the most common schemes consists of callers introducing themselves as Medicare agents to “verify” your new Medicare card number to make sure you received your card. They may even say you need to return your old card. With calls like these the best advice is: Hang up.
People calling to sell Medicare insurance plans or update current Medicare policies by phone
This deceptive scam usually begins as people turn 65 or around annual re-enrollment time. The goal is to get your personal information and money by trying to sell a phony product such as a supplemental or prescription drug Medicare plan requiring a credit card or other payment.
Unsolicited phone calls selling Medicare plans are risky. Medicare displays all approved plans on its website in its Medicare Plan Finder, where you can compare plans and enroll. There are also certified insurance brokers who can help demystify the choices and answer your questions.
Sending a bill from an unknown hospital, doctor or medical supplier
Scammers send such bills knowing that many people will pay them, thinking they’re receiving another charge from recent medical activity or, perhaps, a portion not covered by Medicare.
Some scammers set up dummy companies to receive the funds. Others use established medical entities and get kickbacks. Scams can even be perpetrated by health care employees with access to your records.
So, keep a calendar and record the exact dates of any health care services you’ve received so you can compare them against bills. Also, save any receipts or statements listing the date of these services. If you are still unsure about a bill, contact the billing department of your hospital or facility, or your insurance provider, and ask if it is a valid charge.
Check your quarterly Medicare Summary Notices to make sure there aren’t tests, procedures, drugs or equipment that you didn’t receive.
Knocking at the door to sell a Medicare plan, medical equipment, medicines or supplements
A Medicare representative will never show up at your door.
Offering fraudulent genetic testing
You may be invited to take cheek swabs for “free” genetic testing to check for cancer or to determine if you have a predisposition for any other serious illness. Often, fraudsters will advertise that Medicare covers the test and will ask for your Medicare ID to file the claim. You might even be asked for other identification to prove who you are.
If you haven’t discussed this testing with your doctor and mutually decided this is a necessary option, it’s a scam. Medicare does not pay for random genetic testing.
Mailing counterfeit sales materials
During Open Enrollment, mailboxes of people 65 and older begin to fill with offers of discounted or new Medicare supplemental coverage as well as prescription drug and Medicare Advantage plans. While some may be legitimate, many aren’t.
If you have questions and are already on Medicare, contact your insurer’s customer service department. Otherwise, head to the Medicare Plan Finder or call 1-800-MEDICARE to determine if what you’ve received is on the up and up.
Finally, if you feel someone is impersonating Medicare, report it by calling 1-800-MEDICARE; the Office of Medicare’s Inspector General at 1-800-HHS-TIPS or through the Federal Trade Commission’s website. Include the phone number of a caller as well as any other information that may help the government find the fraudsters. You can read more about Medicare scams at the AARP site.