The Annual Enrollment Period (AEP) will be here before you know it. AEP is the most popular time of year for beneficiaries to change or enroll in a new plan. However, this means Medicare scams, fraud, and abuse are at all all-time high. Medicare Plan Finder makes understanding these risks easy, so you feel protected year-around.
Medicare Fraud and Abuse
The government loses millions of dollars each year due to Medicare fraud and abuse. This causes Medicare prices to increase. The government has created laws to protect all parties involved in Medicare and Medicaid. These laws promote healthy relationships between agents, carriers, and clients to prevent the insurance industry from becoming profit-based, instead of care-based. Your coverage should be more important than profits.
Medicare fraud includes:
- Knowingly making false claims or misrepresenting data
- Intentionally giving or receiving rewards for goods and services
- Promoting one health service over another
- Billing Medicare for appointments that never happened or for more than what actually happened
Medicare abuse includes:
- Billing for unnecessary services
- Excessive supply purchases
- Misusing codes
Medicare Fraud and Abuse Laws
The government has implemented the following:
- False Claims Act (FCA) – Protects the government from being overcharged on goods or services. No proof of intent is required.
- Anti-Kickback Statute (AKS) – Agents cannot knowingly reward referrals for health care programs.
- Physician Self-Referral Law (Stark Law) – Doctors cannot make referrals to health care companies in which they have an interest.
- Criminal Health Care Fraud Statute – Cannot defraud; bill for unnecessary medical goods and services (like drugs that are not needed or wheelchairs for those who are not impaired).
What Can You Do?
Don’t become a victim! If you aren’t sure about a health agent’s validity, ask for licensing information or work with Medicare Plan Finder. To help fight Medicare fraud and abuse, report any suspicious activity to 1-800-HHS-TIPS (1-800-447-8477). You can also describe the incident in up to ten pages and email it to HHSTips@oig.hhs.gov.
Common Medicare Scams
A licensed Medicare agent is required to abide by strict rules when contacting seniors and Medicare beneficiaries. It is illegal for anyone (including an authorized Medicare agent) to show up at your front door without permission. Also, keep in mind that no one associated with Medicare will ever call you to update your information.The following are common Medicare scams you need to look out for:
One recent scam involves adults calling the elderly and pretending to be their grandchildren asking for money. They’ll say that they are in some form of trouble and need money. To avoid this grandparent scam, be sure to ask for a personal detail that only your real grandchild would know the answer to. It is easy to assume you would recognize their voice, but if someone calls in a panic, your adrenaline may kick in, and their voice is the last thing you’re worried about.
Medicare Phone Scams
Medicare phone scams are probably the most common way that seniors and other Medicare beneficiaries are taken advantage of. In some cases, a scammer may call you and pretend to be from Medicare and offer you free services if you provide your Medicare number or Social Security number. In other cases, a scammer who claims to be from Medicare may say that they need to validate your information to keep you from losing your benefits. The real Medicare program will never ask for this information. Never give these numbers away over the phone.
One phone scam in particular, the “can you hear me” scam, is easy to fall victim to. The scammers use this question to get a “yes” answer from people, which they would then edit to make it seem as though they were agreeing to purchase a product or submit information. If you answer the phone and someone you don’t know asks, “can you hear me?” hang up right away.
Scammers will often try to catch your attention by saying you have Medicare refunds. The scammer’s goal is to get your bank information. Common reasons for Medicare refunds include changes or enhancements to Medicare or lawsuits with private insurance companies. If for some reason you are entitled to a Medicare refund, a check will be mailed to you directly. No one will ever call asking for your bank information.
How to Avoid Medicare Scams
Medicare scams can be easily avoided. CMS (Centers for Medicare and Medicaid Services) suggests the following tips for avoiding scams and fraud:
- Treat your Medicare card like a credit card. Keep it in a safe spot and never give out your number to anyone other than your doctors.
- Do not accept an offer for free gifts or money in exchange for your Medicare information.
- Don’t accept services that aren’t usually covered by Medicare unless a doctor that you trust tells you that it is necessary.
Will Medicare Ever Call You?
Medicare will never call you randomly and ask personal questions. If you are already covered by Medicare, they have all the information they need. If someone from Medicare needs to contact you, they will find a more official communication route. If you have any additional questions about Medicare communication, or if who is contacting you is legitimate, contact a Medicare customer service representative at 1-800-MEDICARE.
Free Stuff for Seniors From the Government
Seniors and Medicare beneficiaries can fall into specific categories that scammers will use to their benefit. Scammers will sometimes call pretending to be from the government and offer free health checkups or free medical supplies. During these fake calls, they will use common senior health conditions to act like they know specific details about your health. The scammer has no idea you have diabetes or high blood pressure; all they know is that a handful of seniors have those conditions. Scammers are hoping you will also fall into that category.
Some scammers have been known to give names and addresses of your doctor. It is unknown how they receive this information. Even if the caller ID looks reputable, don’t trust them so quickly. Technology has continued to evolve and faking caller ID has become easier and easier. Don’t trust if someone says they are providing free products or services from the government. Scammers will say all you have to pay for is shipping costs, then get access to your credit card information.
Protecting yourself from Medicare scams may seem like an impossible task. Now that you understand the common Medicare scams you will know what to watch out for. If you are ever suspicious or have questions regarding Medicare fraud, call the Medicare Helpline. They can answer any questions you may have. The Medicare Helpline is a 24-hour toll-free line and can be reached at 1-800-MEDICARE. Also, you can help eliminate Medicare fraud by reporting suspicious activity. Call the Medicare fraud line at 1-800-447-8477 or email the incident to HHSTips@oig.hhs.gov.
Enroll in Medicare
The risks of Medicare scams does not lower the importance of proper Medicare coverage. We are dedicated to helping you choose the best plan from all of the options available in your area. Why do we need your information?
- Zip Code: We need this because Medicare plans are different in every zip code.
- County: We ask for your county because sometimes zip codes fall into more than one county.
- Email and Phone Number: We ask for your contact information because we want to have a conversation with you about helping you find a great health plan.
- Birthday: Sometimes we’ll ask for your birthday to help us ensure that you qualify for Medicare benefits.
Medicare Plan Finder and other legitimate resources will not ask for your Social Security Number or Medicare number before speaking with you. If someone who you do not know asks for your SSN or Medicare number, do not give out that information until you know that it is safe to do so.
We are here to discuss the best Medicare coverage for your needs and budget. If you’re interested in speaking with a licensed Medicare agent or scheduling a free no-obligation appointment, fill out this form or call us at 833-438-3676.
This blog was originally published on 10/1/18, but was updated on 5/7/19.