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Too good to be true, YEP it probably is! Medicare Fraud can be a problem

“Busy Brain” nights when I simply cannot shut off my brain to go to sleep may cause me to turn on the TV for some mindless program that will hopefully, put me to sleep. In the process, I will be subjected to the onslaught of commercials. It’s always amazing to see how many of the ads are for medications that list potential side effects that include things far worse than the ailment for which they might be prescribed, some of which include death!

Conversely, there are the ads for products that are “free” that could sound pretty enticing. Typically the ad says something like this, “If you have Medicare, this (brace, electric wheelchair, ostomy supplies etc.) is FREE for you! Call in today, give us your Medicare number and we’ll send you your item!”

Well, you might think, “It’s free I have nothing to lose. Might as well give it a try”. But remember the old saying, “There is no such thing as a free lunch”. These ads are representative of some of the biggest Medicare fraud scams being perpetrated today.

If Medicare pays for the device, you and your fellow Medicare beneficiaries are actually paying, because those costs are passed on to the consumers in the form of rate increases! Also, if you get the “free” item that is not really needed, when the time comes that you might actually need the equipment, it could be denied because you have already received one. The fact that you got a sub-par device that quickly broke, will not protect you.

These companies are often going to scam you further. Would you proceed if you knew you were agreeing to these conditions, merely by phoning in to the company?

“By calling in, I confirm that this will serve as my signature authority for COMPANY and their customers to call me on my telephone at the number provided. I am aware of my rights to protect my privacy and these rights are waived for the purpose of COMPANY and their customers to call me. I consent to receive information on products not limited to spinal support braces and/or knee braces on this phone call or subsequent phone calls … I am permitting calls to be automatically dialed. … If I am on a do not call list, by opting in, I am waiving this right.”

Some of these scams will hook you into continued deliveries of supplies, promising that you pay nothing, but then sending bills for hundreds of dollars with each delivery. You will likely start receiving calls from all of their associated vendors trying to bully or trick you into participating on more items.

Karen Fletcher writes the following in a recent issue of California Broker, “One of her residents complained to her about receiving numerous unwanted packages from DME (Durable Medical Equipment) companies (10 in total). This service coordinator…immediately suspected fraud and called HICAP/SMP.

With a little investigation, SMP (Senior Medicare Patrol) found that this all started when the resident called the number on a TV commercial advertising braces, similar to the commercial mentioned above. The resident received more braces than she had agreed to, and when she refused the additional braces, the DME company told her it was a package deal and she had to take them.

In looking at this beneficiary’s Medicare Summary Notices, SMP also found that Medicare has already paid thousands of dollars’ worth of unnecessary braces on this beneficiary’s behalf. In total, Medicare paid nine claims from six different DME suppliers, most of whom probably got this beneficiary’s Medicare number from the original company she called regarding the TV ad.”

So how do we help reduce or prevent the billions of dollars of Medicare fraud?

  1. Never give out your Medicare card number, Social Security number, birth date, bank account info, or credit card number to an unknown party.
  2. If you think you need a medical device, talk with your doctor to get a prescription for the proper device. Then shop around with local vendors.
  3. Keep an eye on your Medicare EOB’s (Explanation of Benefits”. If you see one that comes in for a product or service that you did not have, call Medicare or go online to: https://oig.hhs.gov/fraud/report-fraud/
  4. If you receive a call from a suspected scammer tell them you’re going to report them for Medicare fraud and you’d like to be removed from their list

Finally remember the saying, “If it sounds too good to be true, it probably is!”

Margaret R. Beck

Margaret Beck CLU, ChFC, CEBS started her insurance practice in Redding in 1978. She is the founder of Affiliated Benefit Services where businesses and individuals are assisted in choosing proper products, compliance with complex benefit laws and claims issues once coverage is placed.

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