How to Avoid Medicare Fraud


Federal authorities recently charged more than 100 medical professionals for Medicare fraud conspiracy. The defendants conspired to defraud the elderly medical program that is worth more than US$225 million. The defendants came from eight major cities a third of which are from Miami.

Similar charges were made against 94 professionals July of last year.

However, consumer advocates believe that Medicare is not the only government program that is being ripped off. In most cases, Medicare’s clientele become subject to and fall prey to cons. When these things happen, it is the elderly who suffer financial losses. They are ill-equipped to handle such cases and the thought of conducting investigations are close to quixotic. The likelihood of being embarrassed is high considering the thought of being fooled especially when they are often not familiar where to look for help on how to recover their money.

But how does one detect Medicare fraud?

Scammers often pose as Medicare experts and will ask for bank account or credit card numbers. From there, it results in a domino-effect in which victims’ savings are either wiped out or credit card bills become surprisingly astronomically high. Worst, it is just the first among the steps toward identity theft.

Scammers have a way of getting personal information from policy holders. Their usual approach is that they make calls and claim that they work from the federal government. This will lead to information verification such as simple home address validation or if the Medicare client frequents a particular senior center.

They are master craftsmen in building trust and credibility. Finally, they would zoom-in on the client’s Medicare number the way banks ask credit card holders for specific information.

So, what can Medicare clients do? The commonly suggested thing to do is treat one’s Medicare number the way clients should value their credit card number. Common sense suggests that you won’t tell someone you don’t know your credit card number, especially over the phone, os why not do the same for your Medicare number?

All this sounds simplistic doesn’t it? Not really.

Scammers capitalize on changes in health coverage that elderly clients may not often understand well. New laws and policies are being used as a front to elderly clients who are not yet familiar with new laws and policies. An example is the Patient Protection and Affordable Care Act that was passed on March 23, 2010.

The Obamacare became a favorite subject of con artists as they used the new insurance policies to hawk for elderly victims. Scammers would go door-to-door and sleekly lure their victims that this new “policy” had limited enrollment period. Thus, it creates a hastened feeling among the elderly. Not wanting to lose health coverage, the elderly now entrusts the hawker for information he wouldn’t and shouldn’t give out.

At other times, scammers also used health care reform to call up Medicare client, pose as a federal government employee, and offer US$250 for the client’s “doughnut hole.” A doughnut hole is the gap when a person’s drug costs are too high to be covered by basic Medicare, but not enough to qualify for catastrophic coverage. In exchange for this doughnut hole, the scammers would require seniors to provide their bank account or Medicare number to receive a direct deposit.

How can Medicare fraud be prevented? It is true that Medicare provide the US$250 to help with the doughnut hole, that money is sent directly, and no one from the government calls for crucial information since there are no forms to fill, just remember not to give personal information to anyone who calls you about the US$250 rebate check.

Also, a great number of people come into the program without really understanding what’s in store for them or how the program works. Even if they are not getting scammed, the elderly may be participating in one. Scammers may offer freebies such as free lunch or gifts (even money) and in exchange they go visit a clinic for a medical test. This leads to getting information that scammers want in the first place.

Again, to protect yourself from scammers, it becomes crucial that you protect your Medicare number. It would also help if you keep a health care journal with you. The journal will help you keep track of expenses, medical appointments, and tests you will be subjected to or those that you’ve received. Human error is possible, but it could also be likely that you’re being scammed.