FRAUD RESOURCE CENTER
Medicare and its more than 60 million beneficiaries are under attack from an army of scammers eager to pillage the program. Their primary aim is defrauding Medicare itself — the U.S. Government Accountability Office estimated that the program lost about $52 billion to fraud, abuse and improper billing in fiscal year 2017. Their schemes, however, often rely on targeting beneficiaries directly, stealing their identities or enlisting them as unwitting accomplices.
Medicare fraud usually involves rogue health care providers or medical suppliers who bill the program for services, equipment or medication that they don’t actually provide, or else inflate the cost of those items. Some will even falsify patients’ diagnoses to justify unnecessary tests, surgeries and other procedures or write prescriptions for patients they’ve never examined. Others use genuine patient information, sometimes obtained through identity theft, to create fake claims.
There are numerous ways swindlers exploit Medicare recipients to further their schemes. For example:
- Telemarketers call beneficiaries with offers of free state-of-the-art braces to relieve joint pain. Instead, consumers receive a package of ordinary ankle or knee wraps (or nothing at all), but Medicare gets a bill for thousands of dollars.
- Disreputable home health care agencies try to sign people up for services that Medicare pays for but that they never receive.
- Unscrupulous clinics steal from Medicare by writing phony prescriptions or ordering unnecessary tests and procedures. Another ploy is providing treatment that Medicare doesn’t pay for and then billing it as a different, covered service.
An emerging Medicare scam involves fraudsters calling older Americans or showing up at health fairs or senior living communities offering DNA tests to uncover cancer risks. (They may even mail you a testing kit without prior contact.) The con artists assure you Medicare will cover the tests; in reality, Medicare pays for genetic testing only in very limited circumstances, so you could get stuck with a hefty bill.
Beneficiaries bear some of the cost of rampant Medicare fraud, as the program’s losses translate into higher deductibles and copayments. These scams can also be harmful to your health. If shady operators obtain your Medicare number and bill the program for phony prescriptions or unnecessary medical equipment, you could be denied coverage later for drugs or devices you genuinely need. Take these precautions to avoid getting mixed up in Medicare fraud.
- You receive robocalls or other communications offering medical services or supplies for free if you provide your Medicare number.
- A clinic or other health care facility advertises free services or consultations specifically for Medicare patients.
- A doctor or other provider claims to know how to get Medicare to pay for items or services that normally are not covered.
- Your Medicare Summary Notices (MSNs) — statements you get from Medicare listing recent claims by health care providers — include services, procedures or devices you did not receive.
- Do turn down offers of free medical supplies or equipment in exchange for your Medicare number.
- Do share your Medicare number only with trusted health care providers.
- Do note the dates of medical appointments and the services received on a calendar, and save all receipts and statements from providers.
- Do scrutinize your MSNs as soon as possible after getting them. Make sure the dates and services listed are correct. If something doesn’t look right, call your medical provider’s office.
- Do consider signing up for electronic MSNs (eMSNs) to keep closer tabs on your account. These are emailed monthly to participating beneficiaries, whereas Medicare sends paper statements quarterly.
- Don’t give personal information to anyone who calls out of the blue and claims to be from Medicare, even if your caller ID shows an actual Medicare phone number. Scammers use caller ID spoofing to mask their location.
- Don’t talk to anyone who knocks on your door or approaches you in person and claims to represent Medicare or to be selling Medicare-covered supplies.
- Don’t accept money or gifts to use the services of a medical provider or device supplier. Some swindlers use kickbacks and bribes to obtain Medicare information for phony claims.
- Don’t be swayed by high-pressure tactics, such as a telemarketer’s threat that Medicare will declare you ineligible unless you accept the offer of a “free” brace quickly.
- Don’t consent if someone asks to bill you for a DNA test or other service in the event Medicare declines to pay for it.
- To report suspected Medicare scams:
- Call Medicare at 800-633-4227 (877-772-3379 if the issue is a suspicious charge on your Medicare Part D prescription drug plan).
- Contact the Office of Inspector General of the U.S. Department of Health and Human Services, online or at 800-447-8477.
- Contact the Senior Medicare Patrol (SMP) for your area. SMPs are government-funded, volunteer-run organizations that can help you detect and report Medicare scams.
- The Centers for Medicare & Medicaid Services booklet “Protecting Yourself & Medicare from Fraud” has additional details on detecting, preventing and reporting Medicare fraud.
Published: June 17, 2019
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