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How to Avoid Fraud

Blog February 2nd, 2015
avoid-health-care-fraud

Earlier, we discussed how and why fraud was prevalent in seniors. Today, is on how fraud can be avoided.

Many fraudulence crimes are a result of Medicare fraud and that’s been one of the main reasons our health care system was reformed. Every year, Medicare spends roughly $560 billion and Medicare fraud makes up $17-57 billion of that. Even at the low end, that’s high.

Part of the reason it is so common however is because Medicare, in many ways, functions through a middle-man. Insurers will be billed with signed doctor’s notes at the behest of con artists for the seniors. That sentence alone is a mouthful and aptly shows the trail where things can get muddled.

This is especially true with Durable Medical Equipment (DME) scams. To be covered by Medicare, DME needs to be prescribed by a licensed physician. Doctors must deem the equipment medically necessary. What con artists do however is get the senior’s Medicare number – usually by phone – and then harass/bribe doctors or forge the signatures themselves; some are VERY good at this.

Types of Health Care Fraud

Any time the company or supposed manufacturer offers free supplies. It’s usually a scam. They may end up billing the insurance company, but not deliver the product promised.

Another form of health care fraud comes whenever con artists conduct fake tests that they claim are medically necessary. They usually approach seniors at shopping centers or health clubs, but may even be so bold as to visit a retirement community. They will then bill Medicare for tests that weren’t necessary in the first place.

How to Avoid Health Care Fraud

Never give out your Medicare number except to those have specifically provided you with medical services. This is paramount! Your Medicare number is a lot like your social security number and is only given to those credible and licensed few.

Secondly, never sign an incomplete insurance claim. It’s like writing a blank check.

Third, talk to your physicians and insurers if you have been offered free equipment or if they have received a call about ordering your equipment. Leaving it up to one person you may not know well is a recipe for disaster.

Other Forms of Senior Fraud

Obviously, the most concerning and most common is health care fraud, but there are numerous other forms of fraud that seniors and their families should be wary of. Most of them involve someone asking for their Medicare number, so again, that’s why it’s so important to only give it out to licensed and trusted individuals.

For a complete list of other forms of fraud used specifically among seniors, visit the fbi.gov website for details.

If you believe that you have been the victim of fraud, don’t hesitate to call your insurer, your doctor, or even our care advisors. Our goal is always to help seniors and if there’s anything we can do, we will.

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