Medicare Fraud

Medicare and its more than 60 million beneficiaries are under attack from scammers who want to disrupt the program. Their primary aim is defrauding Medicare itself.  Billions of dollars were lost in 2017 due to fraud, abuse and improper billing. You ask – how can this happen?  Their schemes target beneficiaries directly, steal identities or enlist Medicare participants as unwitting accomplices. 

Medicare fraud usually involves rogue health care providers or medical suppliers who bill the program for services, equipment or medication that they don’t actually provide, or else inflate the cost of those items. Some will even falsify a patient’s diagnosis to justify unnecessary tests, surgeries and other procedures or write prescriptions for patients they’ve never examined. Others use genuine patient information obtained through identity theft to create fake claims.

Here are some ways that fraudsters exploit the Medicare system:

  • Telemarketers Calls to participants with offers of free state-of-the-art braces to relieve joint pain. When received, only ordinary ankle or knee wraps (or nothing at all) is in the package, but Medicare gets a bill for thousands of dollars.
  • Disreputable home health care agencies try to sign people up for services that Medicare pays for but that they never receive.
  • Phony prescriptions or ordering unnecessary tests and procedures are another avenue of fraud.
  • Fraudsters telephoning people or being present at health fairs with offers of DNA tests to uncover cancer risks claiming Medicare will pay for the tests.  In reality, Medicare pays for genetic testing in only very limited circumstances.  So, the end result is the individual gets a hefty bill for the test.
  • Obtaining your Medicare number could result in Medicare being billed for phony prescriptions or unnecessary medical services.  This could result in denial of coverage for services in the future.

So, what should you look out for? 

  • Receiving robocalls offering free medical services or equipment if you provide your Medicare number. 
  • Advertisement for free services specifically for Medicare patients.
  • A health care provider claiming to be able to get Medicare to pay for services not normally covered.
  • Your Medicare Summary Notices listing claims from providers from whom you did not receive services.

What should you do?

  • Don’t accept offers for free medical services in exchange for your Medicare number.
  • Only share your Medicare number with trusted health care providers.
  • Keep track of medical appointments and services on a calendar and keep receipts.
  • Review your Medical Summary Notices.

And, whatever you do,

  • DON’T give personal information to anyone who calls out of the blue and claims to be from Medicare, even if your caller ID shows an actual Medicare phone number. Scammers use caller ID spoofing to mask their location.
  • DON’T talk to anyone who knocks on your door or approaches you in person and claims to represent Medicare or to be selling Medicare-covered supplies.
  • DON’T accept money or gifts to use the services of a medical provider or device supplier. Some swindlers use kickbacks and bribes to obtain Medicare information for phony claims.
  • DON’T be swayed by high-pressure tactics, such as a telemarketer’s threat that Medicare will declare you ineligible unless you accept the offer of a “free” brace quickly.
  • DON’T consent if someone asks to bill you for a DNA test or other service in the event Medicare declines to pay for it.


About the Author

Kay Sowa is a paralegal in the Trusts and Estates Group at Capehart & Scatchard, P.A. She is an IRS Enrolled Agent, an Accredited Estate Planner®, and a Certified Trust and Fiduciary Advisor. She oversees the trust and estate administration practice for the firm. She is an accomplished author and lecturer who has frequently spoken on behalf of a number of organizations including the National Business Institute and the Institute of Paralegal Education.

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