THIS month, more than 40 members of what is said to be an Armenian-American crime syndicate were arrested and charged in an extensive Medicare fraud. Prosecutors say the suspects stole the identities of doctors and thousands of patients, using them at more than 100 bogus health clinics in 25 states to bill Medicare for more than $100 million.
On Oct. 21, officials at a chain of mental health clinics in Miami were charged with making $200 million in fraudulent claims for group therapy sessions that authorities said were unnecessary or never provided.
Medicare scams like these are rampant, costing taxpayers billions of dollars every year. But the schemes are not always so ambitious.
Thieves may simply offer unsuspecting patients medical supplies and equipment they do not need, or do not qualify for, to collect Medicare numbers, said Julie Schoen, director of the California Senior Medicare Patrol, part of a federally financed antifraud program that operates in every state.
The swindlers then bill for other supplies and services the patients never received and pocket the reimbursements. Another common ruse is to offer free services, such as cholesterol or diabetes screenings, to get Medicare numbers.
Medicare recipients caught up in these crimes rarely face financial liability, but compromised medical and insurance records may cause them problems later.
“One woman called me saying her father needed a wheelchair but Medicare denied it, saying he had already had a wheelchair for five years,” said Makeba Huntington-Symons, program manager for the Florida Senior Medicare Patrol in St. Petersburg. “His Medicare number and his records were compromised, and he didn’t know it.”
Some Medicare recipients apply for long-term care or other insurance and find they do not qualify because their medical records are full of fraudulent treatments and tests, Ms. Schoen said. Medicare fraud raises the cost of Medicare premiums for everyone. And when scams get particularly popular, Medicare cracks down on eligibility, making it more difficult for those who really do need, say, a motorized wheelchair or hospice services.
Here is what you can do to protect yourself or a loved one from Medicare fraud — and what to do if you think you might be a victim.
GUARD YOUR CARD Protect your Medicare card as carefully as you would a credit card or Social Security card. Never give your number over the phone to a stranger — for instance, to someone who claims to be conducting a health care survey for the government. And never allow a friend or relative to use your card. Report a lost or stolen card immediately.
BEWARE OF FREE SERVICES Someone offering you a medical service free does not need your insurance information. If you are asked for it in connection with such a service, walk away. This can be a scam to collect Medicare numbers to use for fraud.
Never accept offers for medical equipment, supplies or services that you do not need or already receive. Take it from Joseph L. O’Malley, 76, of Corona, Calif.
Mr. O’Malley, a dialysis patient, was receiving treatment when he was approached by a woman offering him free supplies, including a monitor, test strips and lancets. He told her he was not interested and did not need the supplies. But a week later a package arrived at his house.
Mr. O’Malley concluded that the sender had obtained his address and Medicare number and was billing Medicare fraudulently for the supplies. He reported the incident immediately.
EXAMINE YOUR STATEMENTS If you have traditional Medicare, you receive statements quarterly. Review them carefully, looking for doctor visits that never happened, unfamiliar medical provider names, and supplies and equipment you never received.
You can check claims on your account online as soon as they are posted if you sign up at MyMedicare.gov. Seniors who are not comfortable with the Internet can assign a caregiver the right to check statements online.
If you are part of a Medicare Part D prescription drug plan, usually you will receive a monthly explanation of benefits. Check these carefully.
If you find something unusual, call your doctor or medical provider first. It may be a simple error. If not, report it immediately. (See below.)
AVOID ENROLLMENT HAZARDS Beginning Nov. 15, Medicare recipients can sign up for or change plans. This period is also when criminals peddle bogus Medicare and Medicare D prescription drug plans. Many try to tempt seniors with offers of services and products that are not actually covered by Medicare.
Check any insurance plan you are considering on the plan finder at Medicare.gov. If you cannot find it, it may not be legitimate.
CHECK YOUR CREDIT REPORT Review your credit reports periodically for unpaid medical bills that may be a result of fraud. In addition, it is a good idea to keep a journal of doctor visits and other medical services you receive to compare with any unexplained charges.
MAKE A REPORT If you think you have encountered fraud and you have double-checked for errors with your medical provider, you can report the incident directly to the inspector general at 1-800-HHS-TIPS (1-800-447-8477), or via e-mail at HHSTips@hhs.gov.
In addition, to get seniors involved, each state offers a Senior Medicare Patrol office as part of its State Health Insurance Counseling and Assistance Program. Workers at these offices will help you determine if you have been a victim of fraud and will forward your complaint to government investigators. To find the Senior Medicare Patrol in your state, go to www.smpresource.org.
Be patient after you file a complaint, said Peter Budetti, deputy administrator and director of the center for program integrity at the federal Centers for Medicare and Medicaid Services. Sometimes seniors feel as if complaints have fallen on deaf ears, but the agency does its best to investigate all suspicious activity, Mr. Budetti said.
“Last year, calls to our 800 number triggered 30,000 investigations,” he added. “Just because we don’t call you back doesn’t mean your complaint isn’t being investigated.”
Ms. Schoen referred to a phone call four years ago from a Vietnamese immigrant who had received a wheelchair she did not need and wanted to return. Further investigation found that 30 members of the woman’s senior community were also victims of fraud.
“It takes time,” Ms. Schoen acknowledged. But ultimately 13 providers were taken out of the system, and one went to prison. GET INFORMED For more information on preventing and reporting Medicare fraud, go to stopmedicarefraud.gov. Or check the fraud section of the “Medicare and You” handbook recently sent to all Medicare recipients.
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