We’ve found that a lot of older adults aren’t really sure what kind of medical and wellness expenses their Medicare plan actually covers. And with Medicare’s annual open enrollment period not long past (enrollment ended December 7), it’s more important than ever that seniors know what to expect from Medicare—especially if you changed plans during open enrollment.
Though there’s no way to calculate an exact number, the Centers for Medicare and Medicaid Services (CMS) estimates annual losses from improper claims to be in the billions of dollars. Medicare fraud is a particularly concerning issue in senior living, as most seniors opt to utilize the Medicare system for healthcare coverage rather than traditional insurance.
Fraud comes in many forms. Learn how to spot a con.
While the federal government has taken steps to shut down Medicare scammers, passing legislation like the Affordable Care Act (also commonly known as "Obamacare"), which is designed to reduce this kind of wasteful Medicare spending, fraudsters still slip through the net.
Though the government does have fraud prevention units, one of the best methods for eradicating Medicare fraud is for people like you to keep an eye out for suspicious activities. Generally, these flimflammers seem like legitimate businesses or health professionals, so keep an eye out for these telltale ruses.
Be wary of any person, health provider, or company that:
- Requests or recommends that you sign up for non-approved health or prescription plans.
- Resorts to scare tactics or bullying behaviors to intimidate you (or other Medicare users you know) or their doctors into ordering unnecessary equipment, services, or tests.
- Bills you for services you did not receive or for tests performed during (or related tests in the 72 hours following discharge from) an inpatient hospital stay.
- Attempts to sell you medical equipment or services over the telephone, door-to-door, or via a suspicious website. Be especially careful if a purported provider's website has an overseas web suffix, ads written with an unprofessional tone, many pop-up windows or web site redirects to other web sites, or a shoddy graphic design scheme.
- Applies pressured sales techniques, attempts to intimidate you, or otherwise makes you feel afraid or uncomfortable.
- Requires you to state or type in your Medicare plan ID, Social Security number, or other uniquely identifying personal information in order to provide you with more information, to offer you free or discounted medical services or items, or to fill out their company records.
- Contacts you and purports to represent the US government or Medicare—neither organization actively contacts recipients to sell or recommend particular medical services or equipment.
- Attempts to sell you a medical transportation contract (especially private medical air transport services) as a Medicare-covered service or offers to bill non-medical transport to your Medicare plan.
- Tries to sell you durable medical equipment that you do not need or for which you are not qualified to receive under Medicare guidelines (this is especially prevalent among companies selling scooters or motorized wheelchairs).
You can help stop fraud by reporting questionable practices.
Unfortunately, Medicare fraud is a very real concern that can disrupt senior healthcare, but your activism can help cut it out from the system.
If you become aware of any of these typical fraudulent behaviors, contact either the US Department of Health and Human Services' Office of the Inspector General (1-800-447-8477) or CMS (1- 800-633-4227) to report your suspicions.
The Inspector General also maintains an online reporting form, so you can remain anonymous.
You can also help to improve senior healthcare and prevent fraud by joining a Senior Medicare Patrol (SMP). These publicly-funded volunteer organizations provide educational programs on Medicare fraud and fraud prevention to seniors. They also work to train individual seniors in methods for identity protection and fraud detection.
If you are interested in volunteering for an SMP, more information is available here at the SMP Resource.