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By far the largest types of insurance fraud are scams against government and private health care insurers. The Coalition Against Insurance Fraud estimates that tens of billions of dollars are lost annually to these types of fraud. Additionally, medical identity theft is now a top complaint received by the Federal Trade Commission. Billing fraud is also responsible for huge losses to Medicare funds.

How does this affect a senior on an individual level? Although scammers frequently steal newly issued medical ID cards to take over the owner’s identity, scammers also pose as Medicare officials and ask people to pay for their new cards, which in reality are free. They also phone a potential victims with false news of  refund and ask for  ID numbers and bank account numbers to deposit the refund. 

The Centers for Medicare and Medicaid Services have provided a list of tips to help prevent fraud. The first and foremost is to protect your Medicare and Social Security numbers vigilantly. Treat your Medicare card like you would any credit card.  Do not provide the number to anyone other than your doctor or people you know should have it. Become educated about Medicare with regards to your rights and what a provider can and cannot bill to Medicare.  Review your doctor bills carefully, looking for services billed for but not provided to you. Remember, nothing is free with regards to medical care, so never accept offers of money or gifts of free services. You should be suspicious of your provider if they tell you they know how to “bill Medicare” to pay for a procedure or a service that is not typically covered. Before leaving your pharmacy check to be sure your medication is correct, including the full amount prescribed and whether  you received a generic or brand name medicine. If your prescription is in error, then report the problem to the pharmacist before leaving. 

Remember Medicare will never visit, call, or email you and ask for personal information such as your Medicare number, Social Security Number, address, or bank account number. Medicare already has this information and does not need you to provide it.  When Medicare issues new cards in April of 2019, you will not be required to do anything. You can assume that anyone who claims to be helping you with Medicare and asks for your personal or financial information is a scam artist so close the door, hang up the phone, or delete the email.

“Right now … everyone is being inundated with TV commercials, brochures and other official-looking documents in the mail about all the Medicare Advantage plans. It’s so confusing, and in an environment like that, fraud is rampant,” says Micki Nozaki of the California Senior Medicare Patrol. There are more than 50 million Medicare beneficiaries who can annually opt to swap Medicare Advantage and Part D prescription drug plans which provide scammers with the opportunity to prey on vast numbers of seniors.  

When it is time to compare plans be sure to meet with a trustworthy advisor. Some insurance representatives give the industry a bad name by selling you a policy or plan that does not suit your needs or your budget. Some agents go so far as to ask you to sign a release form allowing them to make decisions on your behalf. Never sign anything related to Medicare without first reading it carefully. Additionally, it is a good practice to have a family member or lawyer review the document before signing it. The non-profit National Council on Aging (NCOA) has a free, brief assessment that allows you to compare plans online. You can also contact your local State Health Insurance Assistance Program (SHIP). SHIPs is a provider of free, federally-funded Medicare counseling via a trained volunteer or staff member. 

Medicare fraud wastes billions of taxpayer dollars annually. With common sense and open eyes, you don’t have to become a victim of these predators. 

If you have questions or would like to discuss anything you’ve read, please don’t hesitate to contact us.

Add Goff, Elder Law Attorney

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