People will find it difficult to believe but fraud and scams in the health insurance sector are quite common. Surprisingly, the federal government in the financial year 2019 alone recovered $2.6 billion in false claims and fraud. The number only shows the cases that were caught, as chances are that there were more fraud and scams that went undetected. Older people or senior citizens are more prone to Medicare scams, as someone can defraud Medicare with their information, or can someone can use their information to obtain treatment for themselves. Scammers try to sell people’s personal information and try to access their financial records. Therefore, it is important for people to quickly recognize these scams and report them to prevent this type of abuse.
Some of the scams that generally take place are discussed below:
Few medical professionals might bill Medicare for services or medical equipment that were never provided. Scammers can impersonate a healthcare provider or a medical office and send enrollees a fake bill. They believe that the enrollee will pay any bill they receive without verifying it. Medicare enrollees need to track their Medicare use. If they are having Original Medicare, then they will get a Medicare Summary Notice in every quarter. Enrollees of Medicare Advantage plan receives an Explanation of Benefits every month.
People should know that these documents are not bills and these documents comprise information about the Medicare services, which the enrollees received during that time frame. The documents list out what Medicare paid toward their care and the amount enrollees are left to pay out-of-pocket. If there are any discrepancies between a bill they receive in the main and their MSN or EOB, then there is a possibility of a scam. Thus the Medicare enrollees need to watch out for bills they receive from hospitals, which they did not visit, bills from healthcare providers whom they do not know, and bills for medical services, which they did not receive.
People should stay alert of anyone who visits their home claiming to be from Medicare. The person may try to sell them a health plan or attract them with free services. Their attempt is just to gather personal information of the people. People should be aware of the fact that Medicare does not send any such representatives to people’s homes for such purposes and hence they should not entertain any such suspicious person. Any Medicare-approved services that are rendered at home are scheduled in advance. Right from a physician performing an annual wellness visit for a Medicare Advantage plan, or physical therapy services, these healthcare professionals never ask people for their personal or financial information.
People should know that Medicare does not call any of the enrollee unsolicited. If they require additional information to process the Medicare application of any applicant, then the Social Security Administration will reach out to that applicant with an official letter asking the applicant to schedule a phone interview. Besides that, Medicare only calls enrollees if they have requested themselves either by writing a letter or by directly calling the Medicare. Though a formal Medicare call may require enrollees to share some personal information, they will never ask for financial information such as their credit card number or banking information. Scammers often try to extract financial information from the enrollees or their Social Security and Medicare numbers but people should never fall for such fraudulent activities. People should always be careful while receiving calls that ask then to confirm whether they received their Medicare card or not, or to activate their Medicare card or to renew their Medicare Card. People should also be careful from the call that claim that Medicare owes them a refund or calls that threaten to cancel their Medicare coverage if they don’t update their information.
People should know that Medicare open enrollment period starts from October 15 and ends on December 7. Senior citizens receive innumerable mail about different Medicare plans during this period. Some of the information may be genuine while others are just fake advertising, so people need to separate facts from fiction. People need to be aware of some facts related to Medicare to prevent themselves from fraud. People can change Medicare plans only during certain enrollment periods. Medicare Part B premiums are fixed based on people’s income, and unless people qualify for a Medicare Savings Plan through Medicare, their Part B premium will not reduce. People should know that while Medicare Advantage plans may include prescription drug coverage but they can also sign up for a Medicare Part D plan with Original Medicare. People who are new to Medicare and wish to obtain accurate and genuine information should go to the Medicare Plan Finder. It is an official government site that lists details of all the approved Medicare plans, in which people can enroll through the site as well. People who feel comfortable speaking with an insurance agent should make sure that they speak with a certified agent.
If any individual has been a victim of the Medicare scam, then they should immediately report the incident because it is important to hold the suspicious people accountable so that others are prevented from being subjected to the same scams.