Protecting yourself against Medicare fraud and abuseUpdated January 16, 2018 Medicare
Unfortunately, as the nation’s population of older Americans continues to grow, so too, do cases of elder abuse. While that abuse can take on many forms, one of the most common is financial exploitation. It’s estimated that about 20% of older adults have experienced this problem in just the last year alone.
A significant amount of that exploitation is related to Medicare. The best way to combat Medicare fraud and abuse is to recognize it and stop it before it happens. That means you need to know the warning signs of possible abuse as well as what some of the more common scams are that currently target Medicare beneficiaries.
The most common scam that criminals use to prey on unsuspecting beneficiaries is identity theft. With your confidential Medicare information in hand, perpetrators can do all kinds of damage to your personal finances.
Medicare identity theft can happen in many ways. Typically, someone posing as a Medicare official may contact you by phone, or by mail under the guise of updating your medical records, or wanting to help you re-evaluate your coverage. They will ask you for your personal information such as your Medicare number, Social Security number, and bank account information. The caller may also try to claim that they need to verify the information to continue processing an overdue medical bill.
Remember this always….Medicare already has this information and does not need to collect it from you. A legitimate Medicare representative will NEVER ask for your personal information by phone or through email.
You may also be contacted about being issued a new Medicare card. Medicare is updating all beneficiary’s cards starting in 2019. New cards will no longer contain your Social Security number, but you do not need to do anything. New cards will be mailed to you automatically.
One way to prevent identity theft of your Medicare card and information is to photocopy your Medicare card and cut it down to wallet size. Then remove or cut out the last four digits of your Social Security number and carry the remaining photocopy with you rather than the actual card. One caveat, you will need your original Medicare card the first time you visit a health care provider, but after that they will most likely make a copy and keep it on file.
If your Medicare card has been lost or stolen, or you can no longer use it because it is too faded or damaged, you can replace it by calling the National Social Security Hotline at 800-772-1213. You can also apply for a new card online or go to your local Social Security office.
If you suspect you are a victim of identity theft or you think you gave your personal information to someone you shouldn’t have, contact the Federal Trade Commission.
Another type of Medicare scam is fraud. This takes place when Medicare is billed for services or supplies that a beneficiary never got. This can happen a couple of different ways.
If someone obtains your Medicare card information, they can bill Medicare and then pocket the money for the fake services. Likewise, a healthcare provider could bill Medicare for care a beneficiary never received, also pocketing funds for services that were never rendered.
To minimize the chances of fraud, check all your medical bills, Medicare Summary Notice, explanation of benefits and credit reports. Consider these things as you review these documents:
- Were you charged for any medical services or equipment that you didn’t get?
- Do the dates of services and charges look unfamiliar?
- Were you billed for the same thing twice?
- Does your credit report show any unpaid bills for medical services or equipment you didn’t receive?
- Have you received any collection notices for medical services or equipment you didn’t receive?
Another form of fraud can take place when you are trying to decide which Medicare plan in which to enroll. Not every plan is the same, and insurance sales calls and presentations can be biased, only presenting you with certain benefits and none of the shortcomings. Some sales people may even employ scare tactics or less than reputable tactics to get you to sign on the bottom line.
To avoid being pushed into a less than ideal plan for your personal situation, you need to get unbiased advice from a resource you can trust. My Medicare Matter’s Medicare Questionnaire, created by the non-profit National Council on Aging (NCOA), is a free, brief assessment that helps compare plans online. It can also connect you to free professional advice from licensed Medicare advisers at the Aon Retiree Health Exchange. Aon advisers have passed NCOA’s rigorous consumer protection standards, known as the Standards of Excellence.
Another resource is your local State Health Insurance Assistance Program (SHIP). SHIPs provide free, federally-funded Medicare counseling through a trained staff member or volunteer. You can schedule an appointment with a counselor by visiting their website or call their toll-free national number at 1-877-839-2675.
When in doubt, contact Medicare
If you suspect that a case of identity theft or fraud is taking place using your personal information, contact Medicare immediately. You can visit their website or call them toll-free at 1-800-MEDICARE with any questions or concerns.