Tackling fraud, waste, and abuse is a priority for CMS. Over $100 billion was lost to improper Medicare and Medicaid payments in 2023 alone. Fraud takes its toll on Medicare beneficiaries, as well, in the form of scams. As the number of baby boomers enrolling in Medicare continues to grow, so do the opportunities for Medicare fraud. You play an important role in educating your clients on what to watch for to protect themselves from scams.
Common Medicare Scams
Scams may happen over the phone, by text, by mail, or by email. In all cases, the intent is to steal personal information from unsuspecting seniors. Scammers may ask for a Social Security number, a Medicare ID number, a date of birth, a full name, an address, credit card information, or bank account information. They then use this information for fraudulent Medicare billing or identity theft.
Help your clients recognize these common scams:
A New Medicare Card
The caller will claim to be a Medicare representative and say that the beneficiary needs to replace his or her Medicare card with a newer version, such as a laminated or chip card. To verify the account, the scammer may ask for a Social Security number, Medicare ID number, or other personal information. Remind your clients that Medicare will never call them with offers like this.
Medicare Benefits Have Been Cancelled
The beneficiary learns that his or her benefits have been canceled or he or she is at risk of losing Medicare coverage, usually due to an unpaid premium. These types of scams push the beneficiary to act immediately to avoid losing benefits. This creates a sense of panic, causing the beneficiary to react without thinking rationally. The caller may ask for personal information to verify the account or ask for a credit card to reinstate benefits. Remind your clients that Medicare will inform them in writing if they are ever at risk of losing their coverage.
Offers for New and Better Coverage
The scammer will tell the beneficiary that he or she is eligible for better benefits or lower premiums. The scammer may ask for personal information to enroll the beneficiary in a new plan. Remind your clients that Medicare agents cannot cold call prospects without first receiving their permission. Advise them to never make any changes to their benefits without speaking with you first.
Offers for Free Medical Tests and Equipment
Scammers may call with offers for free or discounted medical tests and equipment. Most commonly, this includes free genetic testing or DME items, such as knee or back braces. They may ask the beneficiary for his or her Medicare ID number to bill Medicare. They might ask for credit card details to cover shipping costs. Let your clients know they should never accept unsolicited medical items they receive through the mail, as there could be fraudulent billing associated with these items.
Eligible for Rebate or Refund
The beneficiary learns he or she is eligible for a rebate or refund from Medicare due to an overpayment. The scammer might request the beneficiary’s personal information to verify the account. The scammer may also request bank account information and the beneficiary’s Social Security number to process the refund. Medicare will never conduct a transaction like this over the phone.
How to Protect Against Fraud
Share these tips with your clients to protect them against fraud:
- Remain skeptical of any unsolicited contact and guard all personal information. Never give out any personal information to someone you do not know. Even the smallest piece of personal data could be used for identity theft.
- Remember, Medicare will not call you if you did not contact them first. They will contact you in writing if they need to reach you. Hang up immediately on anyone who claims to be calling from Medicare. Call Medicare directly at 1-800-633-4227 if you have any questions or want to verify anything. Do not use any phone numbers or email addresses an unknown party gives you.
- Know your benefits. Check billing statements from providers and review claims looking for any suspicious services or overcharging for services received. Ask for itemized statements from providers, and check these against your processed claims.
Report Fraud
If a client thinks he or she has been the victim of fraud, the client should report it immediately by using any of the following methods:
- Calling 1-800-MEDICARE (1-800-633-4227)
- Calling the fraud hotline of the Department of Health and Human Services Office of the Inspector General at 1-800-HHS-TIPS (1-800-447-8477). TTY users can call 1-800-377-4950.
- Filing a complaint online at tips.oig.hhs.gov
If clients have provided scammers with any credit card or banking information, they should contact the appropriate companies. They may want to change the logins and passwords on their accounts.
Let your clients know that you are their primary contact for any questions or concerns regarding their Medicare coverage. Calling you first regarding any unsolicited contact could prevent them from falling victim to scams.
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