Remote health monitoring is the latest target for Medicare fraud : Internet Scambusters #1,103
Medicare fraudsters are constantly finding new ways to trick both program members as well as the organization itself.
The latest ruse is to pretend to be providing necessary equipment and services to monitor chronically ill patients in their homes.
But that's just the tip of the iceberg, and your health and finances could be put at risk if you fall victim, as we report in this week's issue.
Let's get started…
15 Ways To Beat Medicare Fraudsters
A new type of scam has been heaped onto the pile of Medicare frauds that are costing the US health insurance program - and its 60 million members - billions of dollars every year.
Fraudsters are taking advantage of advances in technology to exploit what is known as remote patient monitoring (RPM) - using internet-linked devices to check on patients, such as those with heart pacemakers, glucose monitors, or blood pressure cuffs.
In a recent alert, the US Department of Health and Human Services' Office of Inspector General (HHS-OIG) warned: "Unscrupulous companies are signing up Medicare enrollees for this service, regardless of medical necessity."
Scammers use cold calling, internet, and even TV ads to target victims with unsolicited offers of RPM equipment and services, which they may never receive, they don't need, or which haven't been authorized.
"Billing then occurs for set-up, patient teaching, and monthly monitoring of data. Most often, the monthly monitoring never happens, but the enrollee is billed monthly anyway," the alert says.
Another scheme to have surfaced recently involves allegedly fraudulent Medicare Advantage program activity. Medicare Advantage programs are those that mirror traditional Medicare, packaged with other additional benefits.
One suspected offender, accused of submitting false information about chronic ailments, recently agreed to return $53 million in alleged overpayments to the Centers for Medicare and Medicaid Services (CMS).
These incidents are merely the latest in a host of frauds that swallow up an estimated 10% of the entire Medicare annual budget.
And it's not just CMS and US taxpayers who are losing out. Individual Medicare enrollees face a number of risks that can affect them directly, both financially and health-wise.
Today's Most Common Medicare Scams
In addition to the schemes highlighted above, today's most common Medicare and Medicaid scams recently identified by AARP, the organization for retired people, include:
- A new round of Covid 19 fraud, mainly involving test kits but leading to theft of identity information.
- Bills for unneeded diabetes supplies and equipment.
- Poor quality medical equipment, notably knee and back braces.
- Fake genetic testing at events like health fairs. Medicare doesn't normally cover these tests, so victims may end up paying out of pocket as well as having to reveal their Medicare number.
- Hospice fraud, when individuals are unknowingly enrolled in hospice programs. Sometimes, they're tricked into thinking they're signing up for another type of program or benefit.
- Medicaid recertification. Victims are told they need to pay to avoid losing their Medicaid coverage.
- New Medicare cards. The flimsy nature of Medicare cards is being exploited by scammers offering a plastic card with a microchip. Of course, you have to give them your number first, and pay. (We focused on card scams in issue #777: Crooks Ramping Up New Medicare Card Scam.)
- Dubious telemedicine services. Cold-calling scammers have been known to charge victims or Medicare for the call itself, claiming it was a consultation.
Many of these scams lead to identity theft as well as billing Medicare for services, prescriptions, or equipment that have never been provided. Sometimes, the same items are billed twice. Or victims are offered coverage that's not approved by Medicare.
Other known scams that defraud Medicare include billing for unnecessary or non-provided ambulance services and fake medical facilities that submit large volumes of claims.
Protecting Yourself Against Medicare Scams
Medicare beneficiaries owe a duty not only to themselves but also to the American taxpayer to do all they can to spot and stop Medicare scams.
Here are 15 key actions you can take to protect yourself:
- Carefully review all summaries and explanations of benefits (EOBs) and report discrepancies both to the provider and, if not satisfied, to CMS.
- Safeguard your card and your membership number. Only give details to your known health service providers.
- Hang up on unsolicited sales calls, whether for equipment or program membership.
- Be equally cautious of texts and emails with links seeming to relate to your Medicare coverage. Don't click on those links.
- Hang up on calls claiming to be from Medicare unless it's a returned call or you filed a fraud report. Those are generally the only reasons they'll phone you.
- Never accept offers of free medical equipment or other incentives to sign up for devices or services.
- Don't accept telemedicine services or house calls from unknown providers.
- Don't pay upfront for services beyond deductibles and/or copays.
- Beware of aggressive sales tactics that urge you to act quickly or take tests that may be unnecessary. Always talk to your health care provider first.
- Use in-network providers if you can. If you have to go outside the network, carefully check out the credentials of providers.
- Keep copies of all Medicare notices and other documentation.
- Monitor your credit report for evidence of identity theft.
- Trust your instincts. If something doesn't feel right, it could be a scam.
- Be wise online. Check privacy policies carefully before providing information about yourself to organizations offering services, equipment or supplies.
- Report suspected fraud on the Medicare hotline (1-800-MEDICARE) or via the US Department of Health.
Among other risks, individuals victimized by Medicare scams can suffer serious health dangers, either because they don't get the treatment they need or because of the stress associated with identity theft, which could even lead to loss of coverage.
There's one more action to consider in the fight against Medicare fraud - volunteering to join the Senior Medicare Patrol or your State Health Insurance Assistance Program (SHIP).
This Week's Alerts
Scary clones: We all know about fake distress calls from supposed friends and relatives asking for money. But now scammers have stepped up their game by using artificial intelligence to clone voices and videos to trick their victims, according to the British Daily Mail newspaper. Yes, you can no longer believe your eyes, even when it comes to people you already know.
Unbelievable: If you've been seeing mysterious Facebook messages posted by one of your supposed friends/followers saying something like "I can't believe he's gone," we're here to tell you he probably hasn't. It's just one of the latest Facebook scams used to harvest information from those who post a response. Unless you know it's true, don't be tempted to comment.
That's it for today -- we hope you enjoy your week!