11/13/2012 3:45 PM ET|
How to spot Medicare scams
Elderly parents can't always avoid Medicare scammers, so family members may need to help them stay protected. Here's what they can do.
Recently, federal officials made one of the biggest Medicare fraud busts in history, stopping a $375 million home health care scam in Dallas. Dr. Jacques Roy was charged with certifying hundreds of fraudulent claims for Medicare reimbursement and keeping millions in payment for services that either were unnecessary or never provided to patients. He reportedly recruited homeless people as fake patients.
Medicare scams can be elaborate or simple, but the result is the same -- everybody pays the price in higher health insurance premiums. You can help your aging parents stay a step ahead of scammers by looking out for the following.
No, it's not Uncle Sam
Remind your parents that, no, it really won't be the government on the other end of the line if they get a call supposedly about Medicare. Be suspicious if a caller gives a name that sounds official, such as "National Medical Office" or "Medicare National Office," and says you are getting a new Medicare card and will be charged a one-time fee for your Medicare premiums or prescription drug plan. That's the advice from Karen Roberto, a professor and director of the Center for Gerontology at Virginia Polytechnic Institute and State University in Blacksburg, Va.
You should be especially wary if someone asks you for personal information -- such as verifying your Social Security number -- so you can get the new card. If a person calls claiming to represent Medicare and asks for bank routing information to take care of your Medicare premiums, hang up.
Review medical statements
Although it's not exciting stuff, read your health insurance company's explanation of benefits or your Medicare summary notice. Those documents can provide clues as to whether your information has somehow been compromised.
"See what has been billed to your name. Are there charges and dates for services you didn't receive?" asks Alex Johnson, the assistant director of external audit for the Special Investigative Unit of Regence, a health plan that is part of Blue Cross and Blue Shield.
Be on the lookout for double billing for the same thing, says Howard Coan, a spokesman for the Centers for Medicare & Medicaid Services in Baltimore.
Be wary of big promises about health insurance plans
"If it sounds too good to be true, it probably is," says Johnson. Be suspicious of anyone offering you a supplemental program that is cheaper or better than Medicare. Know what it is you're getting and from whom. Think twice if you speak to a provider's office and are told that they think they can get insurance to cover a procedure.
"It's either covered by your program or not. If it's not, or it's a situation where the doctor isn't really known for doing that type of work, you might get stuck with the bill," says Johnson.
To open the door or not?
If someone you don't know comes to your door, assume the worst. No one from "the government" offering Medicare or a prescription drug plan is going to come to your home unannounced. In fact, it is illegal to solicit this way door to door -- an appointment is necessary, says Dusty Hall, an employee benefits agent with CoVerica, a Dallas-based insurance agency.
Also, pay no attention to anyone offering you services who says you can't wait another day to sign up or who won't give you the time for a family member to help you.
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Great deal on medical equipment -- yeah, right
You many need a wheelchair or walker, but if someone calls saying he or she represents a durable medical equipment company that provides medical supplies, assume the person is a phony.
"DME suppliers are not allowed to 'cold-call' consumers to get orders for supplies," says Roberto.
Get clarity on health care changes
There is the potential for scams as a result of confusion over changes in the nation's health care system. In one recent instance, an insurance broker in California canceled the existing Medicare coverage of her clients and enrolled them into Medicare Advantage plans without their consent. In a traditional Medicare policy, the federal government acts as an enrollee's insurance company, whereas under Medicare Advantage the federal government pays premiums to a private insurer to administer benefits.
"The agent allegedly made misrepresentations while marketing the plans. As a result of the change, older adults ended up with thousands of dollars in unexpected medical bills. In essence, this is deceptive marketing aimed at vulnerable elders," says Roberto.
Just say no to freebies
Advise your parents not to accept free offers of medical equipment, health services or gift cards from companies. The catch may be that they are asked for their Medicare or Social Security numbers, which scammers can use for fraudulent purposes, including identity theft.
Talk to your parents
Your parents may not suspect they are being manipulated by fraudsters. Johnson suggests that you consider making an agreement with them: When they get a medical statement, you will go over it with them. It also doesn't hurt to go through your parents' credit report for any unpaid medical bills or equipment they didn't receive. Monitor their credit cards for any medical-related charges that shouldn't be there.
Report suspicious activity if you suspect Medicare fraud
If you think someone is trying to scam your parents, speak up. You can check with the health care provider if charges seem wrong or something is amiss. It could be a simple mistake. If it's not and your gut tells you to take matters further, report the questionable charges to Medicare and contact your state attorney, your state insurance commissioner or your local police. You can report suspicious Medicare activity by calling 1-800-HHS-TIPS (1-800-447-8477), or you can file a Medicare fraud report online to the federal Office of the Inspector General.
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Hospitals and Clinics scam Medicare all the time. They charge $3000 for a blood test where if you look at the bill its loaded with $200 antibiotic wipes and $75 band aids.
START WITH THE MEDICARE CUTS OF 700 BILLION OBAMA CUT TO FUND OBAMA DEATHCARE! START WITH ALL THOSE WHO DON'T BELONG ON MEDICARE LIKE THE WELFARE FOODSTAMPING LIFERS AND ILLEGALS! START WITH FIRING SEBILUS AND OBAMA AND THE REST OF HIS STAFF. HOW ABOUT STOP TAKING MEDICARE OUT OF MY CHECK AND I'LL KEEP MY MONEY!
hospitals,rehab centers,home care,they all milk the system.The government needs to put a price tag on things,such as the max on band aids,asprin,.and toilet paper plies.
The rehab centers for the elderly are really bad with milking the system.Its not the people recieving the care that are breaking the system but the caregivers are really the one's who are the greedy one's.Put a cap on medical care,and use the money to have a organization(more jobs),if there isn't one already,to keep an eye on over stays and over medical treatment that was recieve or not recieved and billed anyway.Even dentists,who know that you have medicaid,milk it by making you come in several times,when damn well it could be done in one or 2 visits,the the prices are acked up also.So it doesn't take a person with a whole lot of brains to figure out where the problem is.
My Father in law who was in a Health Clinic in West La .Medicare paid $ 6- 7000 for a wheel chair that is now sitting in my garage before he passed away.
I am not sure he sat in it twice .
What a scam that "Rehab " sytem is
Any One want a Wheel chair for $100
Medicare scams are everywhere, especially in the Medicare Advantage (Medicare Part C) market. We saw it throughout the state of Mississippi a few years ago when individuals were tricked into enrolling in a plan that they thought would benefit them, but in actuality their providers where not even accept the plan. The smart way to go is to keep Original Medicare and a Medicare Supplement and stay away from the $0 premium plans that people say are free!
Medicare Insurance Finders provides quotes online for Medicare Supplement Insurance, .
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