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Beware: Medical Fraud

Attend a Scam Jam and learn how you can avoid medical fraud

Stephanie Bias takes medical fraud personally.

It's not just that Bias, 55, works as the coordinator for North Carolina's Senior Medicare Patrol, which is housed within the state's Department of Insurance. She experienced a scam.

In early 2007, shortly after her mother's death the previous year, Bias, of Raleigh, was at her mom's house in North Carolina when the phone rang. Thinking she was talking to Bias' 77-year-old mother, the caller asked for her Social Security number and Medicare and secondary insurance information. The caller promised "our doctor" would certify her for an electric wheelchair.

That is when the exchange crossed the line, Bias said. "Having a physician other than my mother's personal physician certify need without examining her is fraud. And it's also fraud to solicit insurance information for the purposes of billing for something that's not needed."

Bias, who was already affiliated with the patrol, reported the scam to Medicare, but nothing came of it.

Medical fraud is widespread, and it's not just targeted at those covered by Medicare. "Age doesn't matter," Bias said. "Everyone is a target when it comes to health care fraud."

Medical identity theft is the fastest-growing form of identity theft, which is outpacing all other crimes in America, according to the Coalition Against Insurance Fraud, a Washington, D.C.- based nonprofit whose members include consumers, insurance companies, legislators and regulators.

Helen Savage, AARP North Carolina associate state director, has been in the business of consumer education and protection for nearly 30 years. She's seen scams become more sophisticated.

"The circumstances under which consumer fraud and health care fraud occur now involve technology that can challenge even those with great faith in their ability to spot a scam," she said.

Computers can seamlessly alter medical documents. Thieves mine websites for user information or purchase enough information about individuals to steal their identities, set up accounts and make health-care-related purchases in their name.

To educate the public, AARP North Carolina participates in Scam Jams, sponsored by state Council on Aging offices in each county. The jams inform older residents about scams aimed at them and how to recognize, avoid and report them or call for help.

Fighting health care fraud has become a federal and state priority. The Justice Department estimates that Medicare fraud costs taxpayers $60 billion a year.

The General Assembly voted last year to add 25 positions in the North Carolina's Medicaid fraud department, nearly doubling its size.

"People are coming to realize it's more cost-effective to be more proactive about fraud," said North Carolina Attorney General Roy Cooper, D. His office has recovered more than $360 million in Medicaid-related fraud over the past 10 years.

"Clearly, medical fraud is a significant and underreported problem that ultimately affects consumers of health care everywhere," he said.

The federal health care law added $350 million nationwide to combat health care fraud over the coming decade. Senior Medicare Patrol programs around the country, including the one Bias heads in North Carolina, have received more federal money to fight health care fraud through education and prevention programs. North Carolina received $300,000.

You can help stop medical fraud by following these tips:

  • Track your medical procedures and the purchase of medical equipment in a journal;
  • Monitor credit reports, medical records and the explanation of benefits forms sent by health insurers;
  • Immediately correct inaccurate records;
  • File a police report to let law enforcement know a crime may have been committed, and send a copy to insurers, medical providers and credit bureaus, and
  • Notify the Federal Trade Commission if the problem is one related to medical identity theft by calling 1-877-IDTHEFT (438-4338) toll-free.

Lisa H. Towle is head of Liskar Communications and a freelance writer based in Cary, N.C.

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