How Beneficiaries Can Prevent Medicare Fraud

Medicare and its more than 62 million beneficiaries are under attack from an army of scammers eager to pillage the program. Their primary aim is defrauding Medicare itself, costing the program billions of dollars a year. Their schemes, however, often rely on targeting beneficiaries directly, stealing their identities or enlisting them as unwitting accomplices.

Medicare fraud usually involves rogue health care providers or medical suppliers who bill the program for services, equipment or medication that they don’t actually provide, or else inflate the cost of those items. Some will even falsify patients’ diagnoses to justify unnecessary tests, surgeries and other procedures or write prescriptions for patients they’ve never examined. Others use genuine patient information, sometimes obtained through identity theft, to create fake claims.

Amid the coronavirus pandemic, scammers are targeting beneficiaries with offers of free COVID-19 tests in exchange for their Medicare number or other personal information, according to U.S. Department of Health and Human Services’ Office of Inspector General. The data can be used for medical identity theft, and victims could end up bearing the cost of an unapproved test or treatment.

Here are some other common schemes swindlers use to exploit Medicare recipients:

  • Telemarketers call beneficiaries with offers of free state-of-the-art braces to relieve joint pain. Instead, consumers receive a package of ordinary ankle or knee wraps (or nothing at all), but Medicare gets a bill for thousands of dollars.
  • Disreputable home health care agencies try to sign people up for services that Medicare pays for but that they never receive.
  • Unscrupulous clinics steal from Medicare by writing phony prescriptions or ordering unnecessary tests and procedures. Another ploy is providing treatment that Medicare doesn’t pay for and then billing it as a different, covered service.

Another Medicare scam involves fraudsters calling older Americans or showing up at health fairs or senior living communities offering DNA tests to uncover cancer risks. (They may even mail you a testing kit without prior contact.) The con artists assure you Medicare will cover the tests; in reality, Medicare pays for genetic testing only in very limited circumstances, so you could get stuck with a hefty bill.

Beneficiaries bear some of the cost of rampant Medicare fraud, as the program’s losses translate into higher deductibles and copayments. These scams can also be harmful to your health. If shady operators obtain your Medicare number and bill the program for phony prescriptions or unnecessary medical equipment, you could be denied coverage later for drugs or devices you genuinely need. Take these precautions to avoid getting mixed up in Medicare fraud.