Recognizing Medicare scams

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:

You are offered free products or services, such as a grocery or gas gift card, if you simply fill out a survey on the Medicare program. The promoter often visits senior centers and adult retirement communities to make the offer. The survey form requires that you enter your Medicare ID and Social Security Number (SSN). A scam artist, often posing as a representative from a medical equipment company, tells you that you qualify for free items like an "Arthritis Kit" or TENS unit to help with pain, along with supplies from Medicare. Of course, they need your Medicare ID number to fill out the paperwork.
You receive a call offering free medical evaluations and testing, or coupons are sent to your home with a request that you call to set up an appointment. Some scam artists actually set up a testing site and give you very basic services, but in order to receive them you're required to fill out a form including your Medicare ID number and SSN. Other promoters just get the information over the phone and tell you they'll call back to confirm the date and time for the testing. Of course, they never do.
You hear from a telemarketer who claims to represent the government or a private insurer. They tell you that they need to make a paperwork correction or offer you a specific service and say they need your Medicare ID number to do so.
You receive a phone call offering you a Prescription Drug Plan approved by Medicare and are told that you only have to make a one-time payment of $299 or $399 for unlimited drugs with no co-pays or monthly premiums. Besides asking for your Medicare ID number, the scam artist also wants your bank account information to make a "one-time withdrawal."

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.