Anyone over 65 years of age or who qualifies for Medicare due to disabilities or a chronic condition is at risk of Medicare-related fraud. This may include people suffering from coronavirus (COVID-19). The majority of this fraud starts with a phone call from a scammer. There are many different variations of Medicare fraud, but what's most important is that you or your elderly loved ones know the different types of scams and how to protect yourselves. This is true for all phone scams like the grandparent phone scam and Jamaican lottery phone scam, which also target seniors.
What Is Medicare?
Medicare is a federally funded health insurance program created for Americans who are 65 or older or who have specific disabilities that qualify them for coverage. There are four different parts to Medicare:
- Part A - is for certain types of health care, including inpatient care, nursing homes, hospice, and home health care.
- Part B - is for certain medical services, including outpatient care, medical supplies, and preventative treatments.
- Part C - is a specialized Medicare plan offered via a private company that works with Medicare to provide Part A and B of Medicare coverage.
- Part D - is for prescription drug coverage.
The first and most important thing future Medicare recipients should know is that you cannot enroll over the phone, even during open enrollment. Once enrolled, the easiest way to avoid fraud, is to know what type of plan you have. Make sure you check your Medicare card and any other insurance cards that you use. You can download Medicare publications to help explain the process. Also download a copy of the Medicare and You Handbook. You can call the phone number listed on the cards to ask for more information if it's unclear what plan and coverage you have. You can also check online at Medicare.gov, or you can call Medicare directly at 1-800-Medicare or 1-800-633-4227. For those who use a TTY phone you can call 1-877-486-2048.
What Are the Medicare Scams to Watch Out For?
Medicare scams are most frequent during the period of open enrollment, which is every year from October 15th to December 7th - but they can happen at any time of the year. For this reason, it's important to be aware of the different types of scams that are circulating.
These are the most common Medicare phone scams:
New Medicare Cards
A caller or in-person impostor says Medicare requires you to give information to receive a new or replacement Medicare card. The imposter asks for your Medicare or Social Security Number and other important information. There is no such thing as new Medicare cards. Cards never expire or are suspended for any reason. Additionally, Medicare representatives never ask for confirmation of information unless you initiate contact. The same holds true regarding representatives of the Social Security Administration (SSA).
Free Medical Products & Services Robocalls
You receive repeat robocalls for the same product or service. These calls come in on landlines and cell phones.
You receive a call offering free medical supplies or free treatment. This is a major scam. These free medical supplies and treatments will often be low cost or never received, yet your Medicare gets billed large amounts of money.
Threats of Medicare Coverage Loss
You receive a call stating you will lose Medicare coverage unless you join a specific prescription plan. Medicare Part D, which covers prescriptions, is optional and doesn't affect your Part A and Part B coverage.
Impostor Calls Requesting Payment Information
You receive a Medicare representative impostor phone call, and they ask you for payment and billing information, such as a bank account or credit card number. Real Medicare representatives are not allowed to ask you for payment over the phone. Hang up on anyone calling and asking for a payment.
Fraudsters often pose as representatives of state or local health agencies, healthcare provider’s offices, hospitals, or fake government agencies. Always confirm all information given by the representative and refuse to give any information over the phone.
Refund & Financial Assistance Scams
Scammers inform you of a refund owed to you because of changes to Medicare or from private insurance companies. They may say the refund is part of a class action lawsuit. Naturally, the caller needs to know your Social Security Number and bank account information. This is a popular scam, and in a new twist the caller may relate it to the COVID-19 pandemic assistance CARES Act. In truth, no refunds or further financial assistance exist. Any monies owed to you from the government will be sent directly and will not ask for necessary “proof.”
Supplement Insurance Scams
Supplement insurance can help people save thousands of dollars, especially if the person falls into the donut hole. Be wary of any salesperson offering discounted or Medigap policies on behalf of, or instead of, Medicare. While some plans help cover the gap, many are scams. Do not give in to high-pressure sales pitches, and be sure to check out the policies with an authorized representative, attorney, or trusted friend or family member.
Fraudulent Billing Practices
This scam can apply to any Medicare or Medicaid services. It takes two different avenues of cheating the system. The first is by promising a Medicare recipient that certain medical practices will be covered by Medicare, even if the plan says otherwise. The scammers claim to know a “back door” to get ineligible treatments approved. The offer is especially tempting to people who desperately need, but can’t afford specific procedures, medical equipment, or medications.
The second part of this scam involves a con artist offering someone a kickback for services not rendered. The fraudster tells the cardholder to make a Medicare claim for treatment. The scammer promises a kickback to the cardholder for making a claim and signing a release form. The scammer gets paid, and the cardholder never sees a dime. Additionally, the con artist requires the cardholder's financial information such as a bank account or credit card number, leaving the victim open to identity theft.
Both scams require the Medicare cardholder to sign a release. The release holds the cardholder legally liable. The signer puts himself in legal jeopardy and can be prosecuted, fined, and/or put in jail.
How Can You Stop Medicare Fraud?
The FBI is working to stop Medicare fraud, but it is still a huge problem. In one of the largest frauds in history, 24 people stole $1.2 billion in a Medicare scheme.
In the international scam which targeted Medicare recipients from all over the U.S., telemarketers based in the Philippines and Latin America were used to call seniors and persuade them to accept free and low-cost knee, back, shoulder, and wrist braces. The braces weren’t needed and doctors prescribed them without reviewing any of the patients. The Medicare paybacks lined the pockets of corporate executives and medical professionals, who laundered it through international shell companies.
Though the FBI is fighting against fraud, it's still crucial that Medicare recipients do the following to protect themselves from scams:
- Know your plan. As mentioned before, if you are unsure of your Medicare plan coverage, you can call Medicare directly at 1-800-633-4227. (TTY phone number: 1-877-486-2048)
- Check your monthly statement. Look for suspicious charges that you do not recognize and report them.
- Consult your primary care physician. Do not make decisions about new prescriptions and treatments without first consulting your healthcare provider.
- Do not trust unknown callers or your caller ID. Fraudsters often make robocalls using a wide variety of numbers. They may also use spoofing to make a number appear legitimate. In general, people making unsolicited calls and offering medical services or products should not be trusted. The same is true for callers stating that they are calling from Medicare. Hang up and call Medicare directly.
- Guard your Medicare information. As with your Social Security Number, keep your Medicare number safe and protected. Only share it with those you trust and whom you know work for and with Medicare.
- Join the Senior Medicare Patrol (SMP). The SMP is a group of individuals dedicated to educating and empowering people with Medicare. The goal of the group is to help people take an active role in detecting and preventing healthcare fraud and abuse.
What to Do If You Suspect Medicare Fraud?
If you or someone you know has been a victim of Medicare fraud, or you suspect Medicare fraud, you can report it to Medicare online or call Medicare directly at 1-800-633-4227. (TTY phone number: 1-877-486-2048). If you have a Medicare Advantage Plan, call the Medicare Drug Integrity Contractor (MEDIC) at 1-877-7SAFERX (1-877-772-3379).
Gather this information before you report a fraud:
- Your full name and Medicare Number.
- The provider's name and any additional information.
- The product or service in question. If it is a product, note the time and date it was supposedly delivered.
- The payment amount approved and paid by Medicare.
- The filing date of the claim. You’ll find this listed on your Medicare Summary Notice or claim.
You can also report phone numbers related to Medicare phone scams to the Federal Trade Commission (FTC).
Additionally, help warn others by downloading our iPhone caller ID app. If you don't have an iPhone, then first run a reverse phone lookup on the scammer's phone number on our website, and then report it, so other visitors know to avoid this number.