Commissioner Causey warns consumers to Medicare, health insurance scams

RALEIGH — North Carolina Insurance Commissioner Mike Causey sounded the alarm to North Carolina Medicare and health insurance consumers as the end of the open enrollment period nears for both Medicare and the Affordable Care Act programs.

"We are getting numerous complaints from ACA consumers across the state who believe their plan was changed without their authorization," Commissioner Causey said. "As for Medicare beneficiaries, we are getting reports that they have been billed for equipment and supplies they never ordered."

According to complaints by consumers who bought health insurance on the federal marketplace (ACA), they did not know that their plan was changed until they visited a medical provider and discovered they didn't have the coverage they thought they had.

The Department's Consumer Services Division and Agent Services Division found out, in some instances, unscrupulous agents would re-enroll their clients into a new plan to collect the commission all the while changing their mailing address, email and phone number so they would not be alerted to this fraudulent behavior by being contacted by the new company. This may also affect their taxes as they would receive a 1095A tax statement on the new plan for the premium tax credit.

Another avenue for unauthorized activity occurs when consumers mistakenly click on an ad on social media. When they do so, agents or agencies connected to the ads enroll the consumer in a plan and collect a fee.

The Department of Insurance has limited jurisdiction over these federal insurance plans. However, we can help consumers get their original plan reinstated without a break in coverage by working with the Centers for Medicare and Medicaid Services (CMS) and U.S. Sen. Ted Budd's office.

The Department has received nearly 9,500 Medicare fraud complaints so far this year. Most of the complaints involved consumers being billed for supplies and equipment they did not order or need. Some complaints involve beneficiaries being charged twice for a service they needed only once.

Our Seniors' Health Insurance Information Program (SHIIP) and Seniors Medicare Patrol have worked with CMS to combat this problem.

Commissioner Causey reminds consumers to never give out their Medicare number or Social Security number to anyone except your doctor or people you know should have it. Also, don't accept offers of money or gifts for free medical care, don't allow anyone except your doctor or other Medicare providers to review your medical records or recommend service. Finally, don't join a Medicare health or drug plan over the phone unless you call them.

If you have any questions, please call (855) 408-1212 between 8 a.m. and 5 p.m. Mondays through Fridays to speak to a consumer expert.