The Huge Medicare Scam Costs That Hit Every Pocket

10 tips you can use to avoid being sucked into a Medicare scam that could be costing us all $40 billion: Internet Scambusters #371

Whether you’re a senior or not, if you pay taxes or Social Security you’re helping to foot the bill for a Medicare scam.

And if you’re a recipient of Medicare, it’s easy to get drawn innocently into the scam, either as a victim or an unwitting accomplice.

With health care issues hitting the headlines every day, it’s a subject that affects us all and everyone can all help limit the scope of the Medicare fraud artists, as we explain in this issue — including 10 important tips to help you avoid the scammers.


The Huge Medicare Scam Costs That Hit Every Pocket


Over 44 million Americans could be unwitting accomplices — or victims — in one of the nation’s biggest frauds: a Medicare scam.

At the last count, the nationwide health care program, chiefly serving seniors, had 44,200,000 enrollees.

And though no one’s sure just how much of its $450 billion budget ends up in the Medicare scam artist’s pocket, the figure is likely between $8 billion and $40 billion. Some estimates go much higher.

That’s an awful lot of dollars down the drain.

Trouble is, many Medicare recipients either don’t know (most) or don’t seem to care (a few) about the loss because it’s not out of their wallets. And anyway, maybe, they think, it’s none of their business. But it is.

Most of these Medicare fraud scams result from one of two tricks — billing for services that haven’t been provided (or for equipment that’s been returned), or patients receiving procedures or treatments they don’t need.

Other times though, seniors become the victims themselves, like when the Medicare name is used to sell them products or equipment they don’t need. Often they’re told these are “free” because they’ll be paid for by Medicare but they end up paying when that turns out not to be the case.

Or, they’re fooled into giving confidential information to scammers posing as either Medicare or insurance representatives — blatant phishing used for identity theft.

The fact is that, whether you’re a senior or not, we should all be playing a part to catch these Medicare scamsters.

As the organization itself explains: “It is in your best interest and that of all citizens to report suspected fraud. Health care fraud, whether against Medicare or private insurers, increases everyone’s health care costs, much the same as shoplifting increases the costs of the food we eat and the clothes we wear. If we are to maintain and sustain our current health care system, we must work together to reduce costs.”

Here are ten tips to help you avoid getting sucked into a Medicare scam, whether it’s aimed at the organization or you:

  1. Be wary of a provider or sales person who tells you that something is not normally covered by Medicare but that they know how to bill them to get it paid.
  2. Be suspicious of providers that seek co-payments on clinical lab tests or Medicare-covered preventive services such as PAP smears, PSA tests or flu pneumonia shots.
  3. Don’t give in to people who use pressure or scare tactics to sell you high-priced medical services or diagnostic tests; always check with your regular physician.
  4. Same goes for people who use telemarketing and door-to-door techniques to sell you things they say you need. These are particularly targeted at people with arthritis, diabetes or sleep problems.
  5. Don’t believe sales people who say they’re from Medicare. The organization doesn’t call or visit enrollees to sell anything.
  6. Never give out your Medicare Health Insurer Claim Number (on your card) except to your physician or other Medicare provider. Treat it with the same security you apply to your credit card or Social Security number. Don’t carry it with you unless you need it.If someone tells you an item is free but that they just need your Medicare number for their records, don’t believe them. This would be highly unlikely.
  7. Don’t allow anyone, except appropriate medical professionals, to review your medical records or recommend services.
  8. Look out for three strange things on your billing statement: – Charges for something you didn’t get. – Billing twice for the same thing. – Services that were not ordered by your doctor.
  9. Always ask questions of your provider or health care plan when you don’t understand the billed charges, when you don’t think you received the service or when you think it might not have been necessary.
  10. Always review your Medicare Summary Notice (MSN) and Part D Explanation of Benefits. You can access your current Medicare account online at MyMedicare.gov.

(Thanks to Medicare and the state of Louisiana’s Stop Medicare Fraud campaign for the above guidance.)

If your physician, provider, or supplier’s office does not help you with your questions or concerns about items listed on your Medicare Summary Notice, or you suspect Medicare fraud, you should call or write to the Medicare company that paid the claim. The name, address, and telephone number will be on the MSN.

There’s also a toll-free hotline for reporting a suspected Medicare scam: 1-800-HHS-TIPS (1-800-447-8477). For more info on what to do if you suspect a Medicare fraud, go to Medicare.gov’s How to Report Medicare Fraud page.

It’s a sensible idea always to keep records of all your health care visits, treatments and medications, including bills, notices from insurers, and prescription drug receipts. And if you rent medical equipment, get a dated receipt when you return it.

If you do these things, you’ll be playing your part in helping to reduce the Medicare scam bill. But if you’re so inclined, you can actually do more.

Since the 1990s, the US Administration on Aging (AOA) has been running a program that used to be called “Senior Medicare Patrols,” now simply known as SMPs.

AOA recruits and trains retired professionals and other senior citizens about how to recognize and report instances or patterns of health care fraud.

In turn, SMP recruits have provided training for more than 2 million seniors, run almost 70,000 group education sessions, held more than a million one-on-one counseling sessions, resolved 113,000 complaints on behalf of seniors and recouped an estimated $105 million.

If you’re interested in SMP, either to join the program or to get one-on-one or group guidance, visit SMPresource.org.

If you need any more help or advice on fraud or other issues related to Medicare, please go to one of the sites we list here or contact your Medicare office.

(Much as we might like to, here at Scambusters we just don’t have the resources or expertise to offer further advice either on SMP or other Medicare related issues — our goal was to alert you to the scams.)

Finally, even if you’re not a senior, you can help the war against Medicare scams by passing on this information to those who are. We’re all in this together.


We suggest you visit last week’s most popular articles from our other websites:

Prevent Identity Theft on Social Networks: Learn how identity theft occurs on social networks and the ways to prevent identity theft from happening to you.

Money Saving Ideas to Stretch Your Budget Further: Anyone and everyone can use these money saving ideas in today’s economy.

When and How to Apply for Secured Credit Card Services: Here’s the low down on secured credit card services that you should read before you take any financial steps.

That’s a wrap for this issue. Wishing you a great week!