The woman could hardly believe her eyes. When reviewing her mentally ill son’s Medicare statement a few years ago, she noticed charges for more than 70 respiratory treatments at a California doctor’s office. The woman knew her son didn’t need such treatments and had no way of even getting to the doctor’s office. So she picked up the phone and called Medicare to complain.
Fast forward to December 2005. The
California doctor and the owner of a
medical billing service were convicted
of fraudulently billing Medicare for
more than $7.6 million in unnecessary
or unperformed treatments for the woman’s
son and dozens of other mentally ill
residents of California board and care
facilities. Our joint investigation with
the U.S. Postal Inspection Service revealed
that the scammers paid kickbacks to marketers
and facility owners and operators to
gain access to board and care facility
residents, then used sodas, candy, donuts,
and cigarettes to entice those residents
to undergo the treatments.
We wish we could tell you that’s
an isolated case of Medicare fraud,
but… We’re investigating
hundreds of similar cases, working
closely with our federal, state, and
local law enforcement partners, the
Centers for Medicare and Medicaid Services,
and other government and privately-sponsored
program participants.
What are the newest scams on
the Medicare block? They
involve the new prescription drug coverage—called
Medicare Part D—that became available
to Medicare beneficiaries nationwide
on January 1. Those who sign up for
the coverage are asked to choose from
a number of available plans.
Some common marketing/enrollment fraud
schemes include:
- Posing as reps from government-approved
private insurance companies, individuals
are going door-to-door to convince
seniors to hand over their Medicare
numbers (which can include their Social
Security numbers), birth dates, and
other personal information. Then, they
use the information to commit identity
theft and other crimes.
- Individuals call to explain their “drug
plan,” then ask for your credit
card number so they can enroll you
over the phone. Instead, they sell
or use your credit card number to make
illegal purchases.
- Someone tries to coerce you to enroll
in the Medicare prescription drug program,
claiming you’ll lose all of your
Medicare benefits if you don’t
participate. Then, they take and use
your personal information.
How can you protect yourself
from potential Medicare Part D scams?
- Be aware that you will NOT lose
your Medicare benefits if you chose
not to sign up for Medicare Part D.
And signing up is free—you should
never have to pay an application fee.
- Protect your Medicare number as
you would your credit card information,
mindful of identity theft.
- Know that private companies can’t
enroll you into a drug plan or ask
for payment over the phone. If you
enroll over the Internet, the company
must mail you a bill.
- Look for the “Medicare-Approved” seal
on all insurance plan materials. If
you don’t see it, the plans aren’t
legit. (A list of approved plans is
available on the Medicare
web site.
Finally, if you think you’ve
spotted—or been the victim of—a
scam, report it as soon as possible by
calling 1-800-MEDICARE. Or, call your local
FBI office .
Resources:
Conviction
Press Release |
How to Protect Yourself from Common Fraud Schemes
Photo
courtesy of the Centers for Disease
Control and Prevention.
