Posted : 07/03/2012
Recently, federal officials made one of the biggest Medicare fraud busts in history - the stopped a $375 million home health care scam in Dallas. Dr. Jacques Roy was charged with certifying hundreds of fraudulent claims for Medicare reimbursement and keeping millions in payment for services that either were unnecessary or never provided to patients. He reportedly recruited homeless people as fake patients.
Medicare scams can be elaborate or simple, but the result is the same -- everybody pays the price in higher health insurance premiums. You can help your aging parents stay a step ahead of scammers by looking out for the following.
Remind your parents that, no, it really isn't the government on the other end of the line. Be suspicious if a caller gives a name that sounds official, such as "National Medical Office" or "Medicare National Office," and says you are getting a new Medicare card and will be charged a one-time fee for your Medicare premiums or prescription drug plan. That's the advice from Karen Roberto, professor and director of the Center for Gerontology at Virginia Polytechnic Institute and State University in Blacksburg., Va.
You should especially be wary if someone asks you for personal information - such as verifying your Social Security number - so you can get the new card. If a person calls claiming to represent Medicare and asks for bank routing information to take care of your Medicare premiums, hang up.
Although it's not exciting stuff, read your health insurance company's explanation of benefits or your Medicare summary notice. Those documents can provide clues as to whether your information has somehow been compromised.
"See what has been billed to your name. Are there charges and dates for services you didn't receive?" asks Alex Johnson, assistant director of external audit for the Special Investigative Unit of Regence, a health plan that is part of Blue Cross and Blue Shield.
Be on the lookout for being billed twice for the same thing, says out Howard Coan, a spokesperson for the Centers for Medicare & Medicaid Services (CMS) in Baltimore.
"If it sounds too good to be true, it probably is," says Johnson. Be suspicious of anyone offering you a supplemental program that is cheaper or better than Medicare. Know what it is you're getting and from whom. Think twice if you speak to a provider's office and are told that they think they can get insurance to cover a procedure.
"It's either covered by your program or not. If it's not, or it's a situation where the doctor isn't really known for doing that type of work, you might get stuck with the bill," says Johnson. (See: "I plan to retire soon: will Medicare be enough to cover my medical care and prescriptions?")
If someone you don't know comes to your door, assume the worst. No one from "the government" offering Medicare or a prescription drug plan is going to come to your home unannounced. In fact, it is illegal to solicit door-to-door -- instead, they have to set an appointment, says Dusty Hall, an employee benefits agent with CoVerica, a Dallas-based insurance agency.
Also, pay no attention to anyone offering you services who says you can't wait another day to sign up or won't give you the time for a family member to help you with it.
You many need a wheelchair or walker, but if someone calls saying he or she represents a durable medical equipment company (DME) that provides medical supplies, assume the person is a phony.
"DME suppliers are not allowed to 'cold call' consumers to get orders for supplies," says Roberto.
There is the potential for scams as a result of confusion over changes in the country's health care system. For example, in one recent instance, an insurance broker in California canceled the existing Medicare coverage of her clients and enrolled them into Medicare Advantage plans without the clients' consent. In a traditional Medicare policy, the federal government acts as an enrollee's insurance company, whereas under Medicare Advantage, the federal government pays premiums to a private insurer to administer benefits.
"The agent allegedly made misrepresentations while marketing the plans. As a result of the change, older adults ended up with thousands of dollars in unexpected medical bills. In essence, this is deceptive marketing aimed at vulnerable elders," says Roberto.
Advise your parents not to accept free offers of medical equipment, health services or gift cards from companies. The catch may be that they are asked for their Medicare or Social Security numbers, which scammers may use for fraudulent purposes, including identity theft.
Your parents may not suspect they are being manipulated by fraudsters. Consider making an agreement that when they get a medical statement, you will go over it with them, suggests Johnson. It also doesn't hurt to go through your parents' credit report for any unpaid medical bills or equipment they didn't receive. Monitor their credit cards for any medical-related charges that shouldn't be there.
If you think someone is trying to scam your parents, speak up. You can check with your health care provider if charges seem wrong, or something is amiss. It could be a simple mistake. If it's not, and your gut tells you to take matters further, report the questionable charges to Medicare and contact your state attorney, your state insurance commissioner or your local police. You can report suspicious Medicare activity by calling 1-800-HHS-TIPS (1-800-447-8477), or you can file a Medicare fraud report online to the Office of the Inspector General.
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