Posted on November 26, 2021 by Kyle Walton
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Posted on November 26, 2021 by Kyle Walton
Unfortunately, almost everyone is all too familiar with fraud. If you have a phone or computer, chances are you have encountered some suspicious call or message from some shady individual who is attempting to get access to your important private information.
Seniors are usually a common target of fraudsters because many people wrongly assume that older individuals are less likely to recognize a scam as it happens. In addition, seniors often possess a wealth of potentially profitable information, such as Medicare policy details, Social Security benefits, and more.
These days, the troublesome reality is that fraud is becoming even more subtle and difficult to detect. This is especially true of Medicare fraud cases, which do not always take the form of a phishing scam via email, phone call, or web page.
Though these scams can and do happen, most Medicare fraud cases are characterized by an attempt to knowingly access important benefits or reimbursements from Medicare that the scammer is not entitled to receive.
Usually, this is done by attempting to steal a Medicare beneficiary’s Medicare number. For this reason, it is incredibly important to never tell anyone you don’t trust what your Medicare number is, or give them access to your Medicare card. Keep in mind that Medicare will NEVER ask for your Medicare number by phone call.
Scammers usually target Medicare beneficiaries in an attempt to retrieve their Medicare number and then bill Medicare for services that were never received. In addition, they may also attempt to retrieve your Social Security or bank account numbers.
A few common Medicare number scams include:
In this scam, Medicare patients are told that if they suffer from arthritis, diabetes, poor circulation, inflammation, or other painful conditions, then they are about to receive a Medicare-approved “kit” that will help relieve pain and is allegedly free to those with Original Medicare Parts A and B. This is not true. There is no such thing as a “Medicare-approved kit” for the treatment of these conditions.
In a home healthcare scheme, a fraudulent physician will claim that a patient is “homebound,” meaning that they are unable to leave their home but are dependent on home healthcare. In the scheme, the Medicare patient is asked to sign forms verifying that a nurse or therapist was at their home to administer treatment, even though no such treatment occurred.
For example, a fraudulent physician will declare that a diabetic patient is insulin-dependent but incapable of self-injecting, requiring a nurse or certified therapist to come to their home and do this for them, but no such nurse or therapist will ever show up.
In these common scams, Medicare numbers are often not the only goal. During the fraud attempt, con artists will also attempt to obtain bank account info in order to steal directly from the Medicare beneficiary.
The scheme begins when a telemarketer calls and identifies themselves as a representative of a prescription drug plan that will provide a year’s worth or prescription drugs for one payment of between $299 and $399.
The beneficiary is then told that payment can only be made via automatic withdrawal, and the beneficiary must provide their Medicare/Medicaid and bank account numbers so that the medication can be issued. If the scammer is successful in obtaining this information, either the money is withdrawn and no prescription drugs are delivered, or the bank account is drained entirely.
There are actually many types of nursing facility fraud. In many cases, a Medicare number is simply stolen by a nursing facility employee and then sold to the highest bidder so that it may be used for fraudulent purposes. Other times, unnecessary and excessive therapy time, treatments, or services are billed to Medicare.
In some cases, a facility engages in a type of fraud known as “upcoding,” which misrepresents services using inappropriate procedural codes that are then reimbursed at a higher rate than required.
Medicare fraud is a crime that affects every tax-paying American citizen and can be incredibly harmful to actual beneficiaries who may find that their benefits are no longer available as a result of fraudulent acts.
While it won’t always be obvious when a person is attempting to commit this crime, it is extremely important to report Medicare fraud cases should you ever encounter them or suspect that you may have encountered them.
The government takes Medicare fraud very seriously. If you suspect your provider or any other individual is committing Medicare fraud, you can call the Medicare hotline at 1-800-MEDICARE (1-800-633-4227).