How to Stop Medicare Fraud From Happening to You

How should consumers protect Medicare card numbers?

Safeguard it exactly as you would any other personally identifiable information. You don’t want your Social Security number floating around in public. You don’t want [to lose] any information that could be used to commit any kind of identity-theft-related crime.

The number is the Medicare beneficiary’s identity. With that, a fraudster can take advantage of their benefits to submit all kinds of fraudulent claims that can have a variety of negative effects on the patient.

Such as?

Such as inaccurate information [entered] in their medical record if a provider is putting, say, a false diagnosis to justify false services that were never provided or weren’t medically necessary.

And that can lead to real-life concerns that might affect their other physicians’ assessment of their [medical] needs, based on inaccurate information in their records.

It can result in beneficiaries getting billed for services or for costs associated with services that they shouldn’t be billed for. And it can result in inaccurate benefit-utilization determinations.

Say a power wheelchair is billed for them, but they don’t know anything about it. And then a few months later, they actually need a power wheelchair for the first time. Medicare is going to say, ‘No, you just got a wheelchair a few months ago.’ That claim is denied.

Then they have to go through all the efforts to try to correct the record and identify what was fraudulent, and get Centers for Medicare and Medicaid Services to reinstate their actual benefits.

How big a factor are telemarketers in Medicare fraud?

This is an increasing trend. Telemarketers are making unsolicited calls to Medicare beneficiaries to sell them or to talk them into some service, or to talk them into trying a “new product” that could help relieve their symptoms or their pain. It could be a better back brace than the back brace that they have. And [they’ll say], “Don’t worry, it’s at no cost to you, because Medicare will pay for it.”

And they will aggressively market to Medicare patients oftentimes things they don’t need. Orthotics is a common one. Sometimes it’s the pain creams. And all kinds of braces: back braces, knee braces, arm braces, neck braces.

Sometimes the fraud is the doctor didn’t even prescribe it. We also see fraudulent use of physician or prescriber identities.

Would you agree with the Federal Trade Commission’s advice: If you get a telemarketing call from a person or business you don’t know, hang up?

Absolutely. If you receive unsolicited phone calls from any kind of medical service provider, be extremely wary.

And don’t purchase anything?

Absolutely. I mean, you wouldn’t take some unsolicited call [from someone] selling you a car sight unseen. We should all utilize due diligence and safeguards.

Any other advice to Medicare beneficiaries?

Know who you are receiving your care from. If you are being solicited by a provider that you don’t know — or that you don’t have any relationship with — be very wary.

And one of the best things that a beneficiary can do — or their family members and caretakers — is look at that explanation of benefits that come in the mail before they get tossed in the trash.

If you see something on that statement that doesn’t look right — you didn’t have that surgery or service or never received that wheelchair or oxygen tank or whatever it may be — then report that suspected fraud to 1-800-HHS-TIPS, the OIG hotline to report suspected crimes.