Medicare scams are on the rise, and they can be very costly for victims. Scammers often target older adults by posing as Medicare representatives or by offering free medical devices or services. There are a number of things you can do to protect yourself from Medicare scams, including:
- Be wary of unsolicited calls and emails. No one from Medicare will ever call you or email you and ask for your Medicare number or any personal or medical information.
- Always check your Medicare Explanation of Benefits (EOB) or Medicare Summary Notice (MSN). These documents will show you all of the medical services that have been billed to Medicare in your name. If you see anything that you don’t recognize, contact Medicare immediately.
- Avoid offers that sound too good to be true. If someone is offering you free medical devices, tests, or services, be skeptical. These offers are often scams.
- Never give out your Medicare number over the phone or online. Only give your Medicare number to trusted healthcare providers or organizations.
List of Medicare Scams
- New Medicare Card Scam
- Medical Equipment Scam
- Prescription Drug Scam
- Home Healthcare Scam
- Medicare Assist and Medicare Help Center Scams
- Medicare Discount Card Scam
Created in 1965, Medicare is a federal program that provides health insurance for people ages 65 and above. It is not dependent on an individual’s income, medical history, or current health. In 1972, the program was expanded to include people under the age of 65 who live with long-term disabilities. Today Medicare helps more than 93 million adults to pay for their medical services including doctor visits, prescription medications, hospital stays, nursing facilities, and hospice care.
Unfortunately over the past several years, several Medicare fraud schemes and scams have been popping up. They are currently on the rise. Scammers resort to deceptive tactics to coerce unsuspecting seniors into giving up their Medicare numbers or other personal information. Often the scammers offer to provide monetary rewards, medical discounts, or free medical devices as incentives. In this article, we take a look at some of the most popular Medicare scams and how to avoid falling victim to them.
Common Medicare Scams
A Medicare scam involves the act of targeting older adults in an attempt to get their personal information. Scammers typically offer non-existent financial benefits, fraudulent promises of services, and misrepresentation of Medicare overall. Because Medicare scams are becoming so common and scammer’s tactics are adapting as technology changes, you should be aware of the latest scams.
Here’s a rundown of some of the most common Medicare scams to date.
1. The New Medicare Card Scam
In a Medicare card scam, a caller will falsely tell you that Medicare is about to issue a new card. They may tell you the new card is plastic or has a microchip. They will also tell you that in order to receive your new card, you need to verify your identity by giving them your Medicare number.
The truth is, you will receive your Medicare card by mail within three months of your 65th birthday. If you do not already receive Social Security benefits or Railroad Retirement Benefit (RRB) for at least four months prior to turning 65, you’ll need to sign up with Social Security to get parts A and B.
How to Avoid Falling Victim to the Scam
- You will never receive a call from Medicare asking for your personal information so you can receive a new card. If this happens to you, hang up the phone.
- Medicare will never call you to ask you for a fee for a new or upgraded Medicare card.
- Medicare will at no time need to call you to verify your personal information.
- Medicare will never, for any reason, threaten to cancel your benefits or revoke your card.
2. Medical Equipment Scam
Each year, Medicare spends billions of dollars on durable medical equipment (DME). This includes braces, walkers, wheelchairs, and numerous other devices that your doctor may prescribe to help you cope with an injury, chronic illness, or disability. Scammers have already picked up on this and have begun to use it as a way to exploit America’s seniors.
In a medical equipment scam, you will receive a call from a person pretending to be a Medicare representative. They may offer you a free medical device such as a walker or a back brace. Often these scammers are very insistent and will try to push you into accepting the equipment, even if you don’t need it. The scammer will tell you that to receive the free medical device, you will need to give them your Medicare number. Once you do this, they will have access to all your private medical information.
How to Avoid Falling Victim to the Scam
- If a scammer offers tells you they are a Medicare representative and offers you a free medical device, hang up the phone.
- You can report a suspected medical device scam to Medicare at 800-633-4227.
- You can also report it to the U.S. Department of Health and Human Services Office of Inspector General fraud hotline at 800-447-8477 or email@example.com.
3. The Prescription Drug Scam
Medicare Part D prescription drug and pharmacy fraud is on the rise. In this type of scam, Medicare is fraudulently billed for medications that you did not receive. In other cases, you may be deliberately given a different medication than the one your doctor prescribed. Look out for the following signs of prescription fraud or abuse. On your Medicare Explanation of Benefits (EOB) or Medicare Summary Notice (MSN), you may see fraudulent charges for:
- Medications or refills that you never received or were not prescribed for you
- Medications that were prescribed by a doctor you have never met
- A different medication (often more expensive) that you were prescribed
- Higher quantities of one or more medications than you were prescribed
- A pharmacy gave you a smaller amount of medication than your doctor prescribed
- You were issued expired medications by the pharmacy
- A pharmacy gave you and billed for a more expensive medication that your doctor prescribed
- A pharmacy refills a medication you no longer require and bills Medicare even though you did not pick up the prescription
How to Avoid Falling Victim to the Scam
- Always make sure that your doctor has examined you and diagnosed your condition before you receive any medication.
- Do not give out your Medicare number or other personal information to anyone on the phone or at a pharmacy.
- If you receive a call from anyone requesting your Medicare information for prescription drug services or free or discount prescription drugs, hang up the phone.
- Always check your Medicare Explanation of Benefits (EOB) or Medicare Summary Notice (MSN) and look out for names of healthcare providers you don’t recognize and billing for prescriptions you did not receive.
- If you see a charge for a prescription you did not receive or you experience any other type of prescription fraud mentioned above, contact your local Senior Medicare Patrol (SMP).
4. The Home Healthcare Scam
Home healthcare offers a wide range of in-home services to seniors who have been injured or have been taken ill. Services may include, nutrition therapy, wound care, injections, and monitoring a health condition.
Check your Medicare Explanation of Benefits (EOB) or Medicare Summary Notice (MSN) for the following signs of Home healthcare fraud:
- Charges for home health service even though you did not meet Medicare’s criteria for such services
- Charges for services that your doctor did not feel were necessary
- Home health services that you did not receive
- Enrollment in a home healthcare service by a doctor you do not know
- A copayment for home health services
- You are asked to sign forms confirming that you received home healthcare services even though you did not receive any
- Someone comes to your home and provides you with medication or housekeeping services but you are billed for skilled nursing or therapy
How to Avoid This Scam
- Always check your Medicare Explanation of Benefits (EOB) or Medicare Summary Notice (MSN) to make sure that you have received what you are being billed for.
- If you wish to enroll in any home healthcare services, only do so through your doctor.
- Do not accept any gifts or incentives, such as gift cards or cash, in return for home healthcare services.
- If someone comes to your home and asks you to sign up for home healthcare services, send them away. Medicare only provides these services if they are also providing you with therapy services.
- Report any charges on your Medicare Explanation of Benefits (EOB) or Medicare Summary Notice (MSN)for visits or services you have not received or any that are different from what you received.
5. The Medicare Assist and Medicare Help Center Scams
In this scam, the caller will tell you that they are a representative with the Medicare Help Center or Medicare Assist. Typically, they will tell you that they need to help you with an issue or correct a problem with your Medicare benefits. They will ask you to confirm your Medicare details, including your number. If you refuse to give your information, the caller may become belligerent or threatening. They may also tell you that if you do not give them your details, your benefits will be canceled.
How to Avoid This Scam
- Note that there is no such program as Medicare Assist.
- The official Medicare Help Center will never call you and ask for your personal information or Medicare number.
6. The Medicare Discount Card Scam
In this scam, someone will call you claiming to be a representative from Medicare, a healthcare provider, or a representative from an insurance company. They will offer you a Medicare discount card if you confirm your Medicare number or other personal information. They will tell you that the discount card will save you money on healthcare services, prescription medications, or medical equipment. Medicare does not offer medical discount cards.
How to Avoid This Scam
- If you receive a call from someone offering you a Medicare discount card, hang up the phone.
- Report the scam as soon as possible.
How to Spot Medicare Scams
Here are some tips to help you be aware of what to look out for and avoid becoming embroiled in a Medicare scam.
- Be Wary of Unsolicited Calls and Emails: Scammers often use unsolicited phone calls and emails to target Medicare beneficiaries. Be aware that no one from Medicare will ever call you or email you and ask you for your Medicare number or any personal or medical information.
- Always check your Medicare Explanation of Benefits (EOB) or Medicare Summary Notice (MSN): If you are enrolled in a Medicare Advantage Plan or Part D prescription drug plan, you will receive an EOB. It itemizes the medical items and services you receive each month. An MSN is a report that itemizes the doctor visits, medical services, and supplies that are billed to Medicare in your name. You will receive it in the mail every 3 months.
- Avoid offers that sound too good to be true: Be wary of being offered free medical devices, tests, or services from someone claiming to be a Medicare representative. Even if they are services or devices that you could benefit from. If you are uncertain about the validity of these offers, hang up the phone and talk to your healthcare provider before you make any decisions.
What to do if You Suspect Fraudulent Activity
If you have received suspicious calls or emails, or you think you may have been the victim of fraudulent activity, here’s what you can do:
- Contact Medicare: 1-800-633-4227
- Contact the fraud hotline of the Department of Health and Human Services Office of the Inspector General: 1-800-447-8477
- Contact the AARP Fraud Watch Network Helpline: 877-908-3360
- Contact the Elder Protection Center: The Elder Protection Center provides an online resource for seniors and their caregivers, offering advice on how to protect seniors from all forms of abuse.
- Review your EOB or MSN: Look for suspicious charges for medications or services you have not received or do not recognize.
- Review your credit report: Fraudulent Medicare claims can have a negative impact on your credit score. Check your credit report for unauthorized charges. You can check your credit status by requesting a free credit report from each of the three major credit reporting companies.
- Notify Law Enforcement and the FTC: You can report fraudulent activity to your local law enforcement and the Federal Trade Commission.
Even though Medicare fraud is on the rise, you do not have to call prey to these scams. You can protect yourself by never giving your Medicare number or other personal details to anyone, either by phone or by email. If you receive a call from someone claiming to be a Medicare representative, hang up the phone immediately and report the scam as soon as you are able.
If you suspect any fraudulent activity within your Medicare account, contact Medicare immediately and explain any suspicious charges to your account for services, treatment, or medications.
You can find out more about Medicare scams and identity theft from these resources:
U.S. Department of Human Services: Medical Identity Theft
Centers for Medicare & Medicaid Services: Reporting Fraud
Consumer Financial Protection Bureau: Guard your New Medicare ID Card to Avoid Fraud