“To scam Medicare is not to give a damn for taxpayers. Money is money whether you earn it or steal it.”

- Anonymous

Christine Seivers of medicalbillingandcoding.org sent me the following list of common Medicare scams. I have edited and shortened her copy to fit my blog.

1. The Poser Scam

One common way to scam Medicare is to pose as a Medicare employee, a practitioner, or insurance representative. These fraudsters call, email, or send letters asking for personal information that includes bank, Social Security, and Medicare numbers.

2. The Healthcare Reform Scam

Healthcare reform is on the lips of everyone these days, and scammers are using it to cash in. Many adults don’t know what the new health care legislation actually entails. That’s just the way criminals want it. It makes many Americans easy targets for scams, like those that claim to sell “healthcare reform insurance” that purportedly protects seniors from any losses to their Medicare or any fines they make incur from not meeting guidelines.

3. The Free Lunch Scam

There is no such thing as a free lunch. Scammers in low income areas are taking advantage of the neediest Medicare recipients by drawing them in to fake health care clinics with promises of free food or gifts. Once they have the victim where they want them, they get Medicare numbers through coercion and then use them to commit Medicare fraud.

4. The Kickback Scam

Scammers might offer you a cut of the take in exchange for your Medicare number, but they won’t put it like that. If anyone ever promises you any gift or monetary rewards for your Medicare number, decline their offer immediately. You’ll be drawn into the scam, and could face criminal charges for your role.

5. The Refund Ripoff Scam

As part of the Affordable Care Act, many senior Medicare recipients may be eligible to receive a refund from the government of $250 to help cover their prescription drug costs. Criminals have pounced on these checks as an opportunity to make some extra cash and scam some Medicare numbers at the same time. Many call seniors and tell them that they need to confirm Medicare numbers to send out the checks. Medicare numbers are like credit card numbers: they should never be given out to strangers over the phone.

6. The Imposter Employee Scam

Anyone can claim to work for the government. Some criminals looking to scam those on Medicare will call or even come to the home of recipients asking for personal information like Medicare numbers and bank accounts. Never trust someone who calls or visits you out of the blue looking for information of this kind.

7. The Free Medical Supplies Scam

Exchanging medical supplies, which are usually of very low value, for Medicare numbers is not a bargain, it’s a scam. If someone tells you that an item is free but they just need your Medicare number for their records, you’re better off buying the items on your own.

8. The Not Usually Covered Scam

If something isn’t covered by Medicare, it isn’t covered. Period. If your provider or someone you don’t know tells you that an item isn’t covered but they know how to bill it so you won’t have to pay, that might sound great. But it’s also fraud and can get you, and that provider, in a lot of trouble.

9. The Extra Equipment Scam

Those with diabetes, arthritis, and sleep problems are frequent victims of this scam. Salespeople will go to homes of those they know suffer from these conditions and try to get them to buy extra equipment, often things that they really don’t need. It sounds great because these extra items can be billed to Medicare and you won’t have to pay a thing.

10. The New Card Scam

Another way scammers are taking advantage of new health care regulations is by telling seniors that in order to keep receiving benefits or get their refund checks they’ll need to get a new Medicare card. This simply isn’t true.

11. The Medical Decisions Scam

Some unscrupulous insurance agents have been taking advantage of Medicare policy holders. Some are sending out release forms that allow agents to make decisions on their behalf. Never, ever sign anything without reading through it first and making sure you understand it. If it’s confusing, get a friend, family member, or lawyer to look over it before signing.

12. The Fancy Tests Scam

Some doctors and nurses are at the center of Medicare frauds. They make their money from scamming Medicare by scaring or coercing patients into getting unnecessary and expensive tests. Your medical provider should never use pressure or scare tactics to get you to consent to any medical decision, it’s just unethical. If you feel this is going on, get a second opinion.

Richard L. Reece is a retired pathologist and the author of The Health Reform Maze: A Blueprint for Physician Practices. He blogs about health reform, medical innovation, and physician practices at medinnovationblog.

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5 Responses for “12 Common Medicare Scams”

  1. John Irvine says:

    would be great to see some hard numbers behind each of these. anybody have any cites? particularly curious about the numbers for the newer reform scams, which seem as though they’re likely to be taking off, given the widespread confusion about what the law means. When even some of the legislators who signed the thing don’t know, you have what can best be described as a potential problem …

  2. DeterminedMD says:

    How about this one I read up on tonight in one of my throw away publications just received today: entitled “Dementia: Hospitalization Common in Final Days”, read this little gem near the end. “Hospitalization generally qualifies a nursing home resident with Medicaid coverage to receive Medicare payments for skilled services, which reimburse the nursing home at a higher rate. In addition, states’ Medicaid payment rates and bed holding policies that pay nursing homes to keep a bed open for hospitalized residents are associated with increased rates of hospitalization. These financial incentives probably result in health care transitions that contribute not only to excessive costs but also to a poorer quality of end of life care.”

    Here’s the stat in the article that should really piss off anyone with half a soul and compassion for quality of life: about 19% of patients with advanced dementia were subjected to at least one burdensome and possibly unnecessary transition between health care sites during their final days of life. 1 out of 5 people are sent to be probed prodded, and just insulted physically for a hospital to make one last buck, at you, the taxpayers’ expense. PPACA might eliminate some of this, but, you don’t think someone in the system is already looking for the loophole to exploit??

    Oh yeah, don’t want to agitate one of the commenters who is behind this agenda. Like we don’t read between the lines of some of the usual suspects who are pining for more of a cut of those trillions of dollars just waiting to be skimmed!!!

    You all want to live forever, but, isn’t there a fate worse than death? Ever meet a person in the throes of dementia you knew previously, and wasn’t it at least sad, if not demoralizing to watch said person be the shell of their former self?

    Not if there was a buck to be made in keeping the person alive!? EH!?!?!?!

    • BobbyG says:

      “Ever meet a person in the throes of dementia you knew previously, and wasn’t it at least sad, if not demoralizing to watch said person be the shell of their former self?”
      __

      Yeah. My Dad.

      http://www.youtube.com/watch?v=vf5DnpdYDqY

      • DeterminedMD says:

        if you are inferring my prior comment was directed to you, it wasn’t, but there are commenters here who support the above behaviors in getting people hospitalized irregardless of need. Just as much as there are commenters here who think that doctors should be put out on ice flows. If there are physicians behind the scenes supporting this disgusting exercise in milking the system at the expense of the elderly, yeah, those folks should be put on ice flows then, not the whole profession though.

        My apologies if you think I was writing this as an affront. I have dealt with dementia professionally and personally my whole life, and it is one reason why I write what I do regarding extending life perversely. And meds like aricept or Namenda are a scam.

  3. Fred Hermon says:

    I wish there were information here about dermitologists who’re BIG TIME ripping off Medicare. I visited one recently in Ridgecrest,Ca. The guy’s running a human flesh chop shop. Is scamming Medicare approx. $2,500 for 20 minutes max of his work. Cuts on 40 patients in two hours. My two visits were a nightmare. He will not talk with patients. After the second visit I asked my family doctor about him. Was told there’ve been dozens of complaints about the dermitologist. I would rather accept death from skin cancer than ever visit that so-called doctor again.

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