Protect yourself against Medicare fraud

Medicare and health insurance often is on the top of people's minds in November, which is typically open-enrollment season. If you qualify for Medicare, you have until Dec. 7 to make selections for 2023.

You could hit a snag, however. Medicare fraud is a $60 billion a year cost to taxpayers, according to Senior Medicare Patrol, grant-funded projects of the federal U.S. Department of Health and Human Services.

During enrollment time, you might discover that you can't enroll because someone else is using your Medicare number to get your benefits, said Angel Hanzik, outreach specialist for Texas Senior Medicare Patrol. Her group takes Medicare fraud claims and helps get them to the right government agency as well as does education on fraud prevention.

Or you might be able to enroll, but then when you get your preventative care, you discover that it is no longer covered because someone else already used your yearly mammogram or blood test screening using your Medicare number. Then you have to pay for those services out of pocket.

Hanzik's group gets multiple calls every day to investigate abuse. Sometimes, it's just a clerical error, that can be fixed. Other times it's actual fraud, which is intentional misinformation for criminal intent.

Hanzik is speaking at a virtual event on Medicare fraud prevention, sponsored by AGE of Central Texas and the City of Buda, on Thursday.

Here are some good practices Hanzik recommends:

Protect your Medicare number

Treat your Medicare number like your Social Security number or a credit card. If it is lost, someone else could be using it. Hanzik says about 250,000 Medicare beneficiaries have had their number used illegally. Once you report it is lost or being misused, it's like a credit card. Medicare will give you a new number.

Keep your card in a safe space and only bring it with you to a doctor's office or hospital when you are going to receive care. If you have an emergency, you can get the hospital your Medicare number later.

Watch for billing scams

Read your health provider's billing statements. Often people don't even read these documents because they don't owe anything. They just throw them into the recycling bin.

Look at every statement. Did you have that service? Are there any extra services on there that you didn't have? If so, call your provider to see if you can get it sorted out. If not, call your insurance provider. If that still didn't get it sorted out and you suspect it's fraud, call Texas Senior Medicare Patrol at 888-341-6187.

From time to time, also look up your account on medicare.gov to see what health care services it shows you've had.

Avoid solicitations

Be wary of phone calls, emails and text alerts. Medicare is not something someone should be selling you. If you have not created a relationship with an insurance company, they should not be calling you. No one should be calling you and asking for your Medicare number to sell you something or even give you something.

Be wary of health fair solicitations. No one at a health fair should be asking your for Medicare number.

Other potential Medicare frauds

Ambulance fraud: You should only be transported in an ambulance if it was medically necessary. An ambulance should have two emergency medical technicians. Other services like a taxi cannot charge you as an ambulance. An ambulance should also charge you the correct mileage and for the correct characterization of the event.

COVID-19 fraud: Be wary of people trying to sell you something or even give you a something that is not part of a known free government program.

Durable medical equipment fraud: Make sure you are not seeing charges for equipment you didn't receive. If you have a loved one, make sure they are not being continued to be charged for equipment after they have died.

Genetic testing: There's a whole scheme with people offering a "free" testing without a physician's order or as a telehealth visit with someone you never meet with. Look for testing charged to you that doesn't apply to you.

Home health services: Make sure all services are ones you've had and are ordered by a doctor you know. You should not be offered "free" services in exchange for your Medicare number. You should not be told to sign anything that said you had a service you did not have or be offered money to say you had a service you didn't have.

Hospice fraud: Look out for being enrolled in hospice services without your permission or without qualifying for it. You should not be offered gifts or incentives for signing up for hospice. You should also receive all the care for which you are billed.

Nursing home fraud: Look to make sure the services and dates you see on a bill match what you received and when you received them. Often more expensive services are billed for than what you received, or the charges continue after you were released.

Outpatient mental health care fraud: The charges should match what you received and the amount of time of each visit matches. Also make sure you are receiving services from a licensed professional.

Prescription drug fraud: The medications you take and the amount of medication you were provided should match the bill. Sometimes, pharmacies will charge for 30 pills but only 25 are in the bottle. That's fraud. Check to make sure medications are not expired. Sometimes pharmacies have been caught giving people a generic but charging for the name brand. You should never receive "free" medication without a doctor's order, or be offered a gift card or compensation to switch your prescriptions over to a pharmacy. A pharmacy should also not refill a prescription that you are no longer taking. You should not be asked to fill a prescription for someone else using your Medicare number.

Telehealth fraud: Check to make sure you are only charged for visits you attended. Look out for people calling you unsolicited family information. It is a scam to charge you for a telehealth visit to order a genetic testing kit you didn't ask for.