A Medicare scam refers to a situation in which an individual or company tries to fraudulently collect healthcare reimbursement from Medicare. And in order to do so, they often take advantage of seniors. There are many different types of Medicare fraud, but they all have the same goal: to bilk money from the Medicare program. If more consumers were aware of all the ways in which Medicare is being scammed and reported scam artists, we'd have as much as 70 billion extra dollars each year to spend on the growing number of older adults who truly need medical care.
How do you recognize a Medicare scam? There are basically two types, but even if you aren't sure that something is a scam, a general rule of thumb is to never give out private financial and insurance information to a stranger, especially anyone offering you something for free.
The most frequent kind of Medicare scam involves healthcare providers who invent ways to improperly bill Medicare for services or products. They use the wrong coding on a claim so that they'll receive a higher payment. This is known as "upcoding" and can involve medical supplies, lab tests, x-rays and other radiology exams, as well as products and services that were never received by the beneficiary. In these instances, the scam artist figures that most people won't look over their Medicare Summary statements and discover the fraudulent claims.
The second type of Medicare scam involves ruses designed to obtain a beneficiary's Medicare number, as well as other personal and financial data. Once scam artists have this information, they can bill Medicare for services never rendered and also enjoy all the "benefits" of identity theft.
The National Consumer Protection Technical Resource Center for the Senior Medicare Patrol program identifies the most common scams used to get someone to divulge a Medicare number:
Remember that Medicare will not call you, so if someone says he/she is calling from Medicare, don't believe it. Keep track of the tests your doctor has ordered for you and any equipment or supplies ordered through a Medicare-certified durable medical goods company. Check your Medicare Summary Notices each month to make sure some "vendor" isn’t being reimbursed for goods or services you've never received.
If you suspect you’ve been a target of a scam, call the Health and Human Services Office of Inspector General at 1.800.HHS.TIPS.