Protecting against Medicare fraud

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We’ve recently heard reports that a variation on an old scam is making the rounds. It sounds like this:

(Ring, ring)

Unsuspecting person who answers the phone:  Hello?

Scammer who is calling:  Ma’am, I’m calling from Medicare. We’re about to send out national medical cards for the new Affordable Care Act.  So I just need to confirm your name, address and phone number.  Oh, and I need your Medicare and bank account number, too…

This kind of scam pops up anytime there’s a big change in a government policy, or when a topic is in the news. Scammers use people’s uncertainty to try to get them to reveal personal information. From there, it’s not much of a leap to identity theft, with scammers using or selling your Medicare number, racking up bogus charges on your credit cards, opening new credit cards in your name, even taking out loans in your name.

You can protect yourself. If you get a call asking for your information, hang up. It’s a scam. Government organizations and the legitimate groups you do business with have the information they need. They’ll never call to ask you for it.

Today we have even more tools to stop fraud—including more law enforcement boots on the ground and more time in prison for criminals.  We’re also using state-of-the-art technology to spot fraud, similar to what your credit card company uses.  As a result, prosecution of health care fraud cases is up 75 percent since 2008.

But for all of our new technology and investigative muscle, the most valuable resource we have in the fight against Medicare are the millions of seniors who serve as our eyes and ears.  Seniors who notice services they never received on their Medicare statements often provide the first tip that fraud is happening, so we’ve redesigned Medicare statements to make them easier to read and understand.  And our Senior Medicare Patrol (SMP) programs are educating seniors, family members, and caregivers around the country about the importance of reviewing their Medicare notices to identify errors and report potentially fraudulent activity.

Seniors are paying attention and they are fighting back against the fraudsters who are trying to steal from Medicare.

A Medicare beneficiary in Texas was asked to sign a work order for his diabetes supplies.  He said that normally he would have just signed and thrown the paper away.  But he had recently heard a presentation from the SMP at his adult day center, so he looked more closely and noticed that he was being charged $7,000 for one month’s supply.  So he asked his home nurse to help him call the National Hispanic SMP and together they figured out that the supplier was going to charge Medicare for 100 boxes of diabetes test strips and 100 boxes of lancets, even though he’d received only one of each.  The SMP helped resolve the case and made sure that Medicare only paid for the supplies he actually needed and received.

A 68-year old Vietnam veteran from California has a medical condition that often makes him dizzy and in danger of falling.  His daughter and his doctor arranged for him to have a motorized chair to help him get around.  But the chair that arrived was not the chair that he ordered.  It was smaller, flimsier, and made by an entirely different manufacturer.  His daughter called the supplier, but their hands were tied—Medicare had already processed the payment for the chair.  So they turned to the SMP for help.  After weeks of investigating, they uncovered that someone had intercepted the order and replaced it with the less sturdy chair.  The SMP was able to work with Medicare to correct the problem, get the veteran the correct chair, and make sure that Medicare wasn’t charged twice.

A senior in Montana received a telemarketing call offering him diabetic testing supplies that he didn’t want or need.  But even though he was clear with the caller that he did not want anything, charges for those supplies showed up on his Medicare statement anyway.  He got in touch with the SMP to see if they could help fix the problem.  Not only did his call mean that Medicare recovered money in his case, it also opened up a broader investigation into the organization that called him and could result in additional savings and prevented fraud.

These three stories are eye opening, but they are not unique.  More than 1.5 million seniors have called SMP programs in cities around the country to ask questions and report potential fraud.  Together they’ve saved Medicare and the federal government in excess of $100 million.

To all of you tipping us off to fraud, thank you.  To learn more about the SMP program and to join us in our fight against Medicare fraud, go to stopmedicarefraud.gov.  Or call the Oregon office of SMP at 1-855-ORE-ADRC (673-2372).

(Submitted by Craig Parker, Senior Medicare Patrol Coordinato with Northwest Senior and Disability Services. He can reached at 503-304-3653.)

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