Advocates warn of scams as Medicare Fraud Prevention Week kicks into gear

When the call came, offering one of Region 10's local clients a back brace, it seemed to be well-timed.

After all, the man was suffering from back problems. He ordered one of the caller's "free" braces. Soon, he began receiving other boxes of durable medical equipment that he did not order — then came the bills.

Judy Dietrich, a certified Medicare counselor through the local Region 10 League for Economic Assistance and Planning's Senior Volunteer Program, said the organization worked with the man to address the problem. His case was referred to the Colorado office of the Senior Medicare Patrol and then, to the Office of the Inspector General.

Although the man's story is timely because this week is Medicare Fraud Prevention Week, the cautionary tale is applicable every day of the year.

"We stress to people to be very careful about who they give their personal information to," Dietrich said Monday.

Scammers are using stealth and tricks to extract this information from older adults. And, with a person's Medicare number, the scammer can bill Medicare for services or equipment.

Medicare fraud can be extensive, totaling in the billions. According to published reports, last July, the U.S. Department of Justice charged 36 people with fraud over an alleged Medicare kickback scheme totaling $1.2 billion. An earlier scam that led to 24 being charged involved overseas telemarketers luring Medicare recipients with free or low-cost braces for backs, shoulders, wrists and knees, according to information from Region 10.

According to Senior Medicare Patrol literature, the federal medical benefit program for older adults loses an estimated $60 billion each year because of fraud, errors and abuse — to the extent it's possible to calculate the loss, that is.

Medicare-related errors can result from genuine billing mistakes. Repeated errors by a provider could signal fraud or abuse, however.

Senior Medical Patrol says that in general, fraud, abuse or errors takes the form of charging for services or supplies that weren't provided; misrepresenting a diagnosis, identity, service provided or other facts to receive payment, or prescribing/providing excessive or unnecessary tests of services.

Fraud can come in many forms and Medicare recipients should be particularly alert to phone calls purporting to be from Medicare that ask recipients to verify their information so a new Medicare card can be mailed. Another red flag: when someone calls a Medicare recipient at home, offering free or lower cost medical equipment, claiming Medicare will be billed for them.

Although for privacy reasons, Dietrich cannot identify clients, she has fielded other calls in recent weeks from area Medicare recipients who were apparently targeted.

One woman reported to Dietrich having received a call asking her to verify her information. Only later, when she saw a TV ad warning people of that very type of fraud, did she realize there might be a problem.

"This woman realized this phone call she'd received several days ago was a scam. The bad thing about it was, she did share (personal) information," Deitrich said.

Region 10 stepped in to help, notifying Medicare and Social Security of what had happened so those agencies would monitor the woman's accounts for fraud.

Even when people aren't tricked, fraudulent calls can be alarming. Region 10's Senior Volunteer Program conducts presentations about Medicare throughout the community, including at senior housing communities. A woman who attended one such seminar had received a phone call offering a back brace.

"She said it scared her, because she was wondering how they knew she had back problems. They don't know. They just keep calling hundreds and hundreds of people," Dietrich said.

As part of a particularly insidious scam, callers phone up a patient and, representing themselves as being from that person's doctor's office, ask them to verify personal information. By spoofing caller ID, they make the call appear to be coming from a physician. "Apparently, that's the newest," Dietrich said, adding that other calls tell the recipients their doctors want them to have a cardiac genetic test and to set an appointment — or, again, offer them durable medical equipment.

"Unfortunately, people do fall for it," she said.

What can people do to better protect themselves or loved ones?

Region 10 and Senior Medicare Patrol advise being leery of aggressive marketing that offers "free" items and services. As with any fraud or scam, treat with skepticism anything that seems too good to be true.

Do not provide personal information or your Medicare number to anyone calling to offer something you did not request. Medicare will not call you unless you first contact Medicare.

People also should carefully check their Medicare summary notices and explanations of benefits (and Region 10 can help with that). Be on the lookout for suspicious charges or mistakes and if you spot anything suspicious, contact your provider for an explanation.

When it comes to medical equipment, secure a written order for it from your doctor. Medicare only covers approved equipment with the appropriate documentation and you have to obtain it from an approved supplier.

To report suspected fraud or errors contact the local Senior Medicare Patrol office at Region 10, 970-765-3129.

"Unfortunately, all taxpayers endure rising insurance premiums and out of pocket costs when Medicare fraud and errors occur and unfortunately, those committing fraud prey upon the vulnerability of patients seeking relief from medical problems," Region 10 representatives said in a news release.

"It is important for all of us to be aware that Medicare fraud does exist and to be wary of all interactions from those who contact us in person or over the phone."