Medicare Care Fraud

Medicare Fraud
Don’t Let It Happen To You

03/22/06

Woman at pharmacy counter with pharmacist 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.

Photo courtesy of the Centers for Disease Control and Prevention.

07.13.10