The Med Diva

An insider's guide to Medicare Part D and more

Archive for the category “Medicare scams”

Countdown to Medicare Open Enrollment: Day 4

Open Enrollment for 2012 begins on Saturday, October 15, and ends on Wednesday, December 7, 2011.

Day 4:  Open Enrollment is open season on Medicare fraud

Yesterday I discussed the importance of being alert to Medicare fraud and scams, particularly this time of year when Medicare Part D marketing is in full swing. According to a 2010 Nightline investigation, Medicare fraud costsU.S.taxpayers more than $60 billion a year. Yes, billions with a “b.”

 To help you better identify fraud and protect yourself—and others—from being scammed, here are a few things to be on the alert for at all times:

  • You’re asked for money or for your personal information (e.g., Medicare
    or Social Security numbers, bank account number, credit card number, etc.) by someone pretending to represent Medicare, Social Security, and/or a Medicare plan sponsor.
  • Another person asks to use your Medicare prescription drug card to obtain drugs at the pharmacy.
  • You’re asked to sell your Medicare prescription drug card.
  • Several payers (insurance plans), including Medicare Part D, are billed for the entire cost of the same prescription.
  • Your Explanation of Benefits (EOB) statement or Medicare Summary Notice lists prescriptions for medications you are not taking or services that were not ordered by you or your doctor.

In addition to being on the alert, you should also carefully review and keep records of your health care visits, services, prescriptions filled, medical equipment provided, significant lab work, etc. It’s also important to file copies of any bills or notices from insurance companies, doctors, hospitals, pharmacies, etc., as well as your canceled checks. Then every time an EOB statement arrives in the mail, read through it carefully and compare it to your receipts to make sure everything is correct.

To learn more about you can help stop Medicare fraud, visit the U.S. Department of Health & Human Services and the U.S. Department of Justice’s Stop Medicare Fraud website. The site has answers to frequently asked questions, as well as important information to help you better understand your EOB statements and find out what to look for in these documents.

The Senior Medicare Patrol (SMP)

If you want to get even more proactive in the fight against Medicare fraud, consider becoming a volunteer with the Senior Medicare Patrol (SMP). SMP is a group of highly trained volunteers who help beneficiaries avoid, detect, and prevent health care fraud. There are SMPs in every state and many U.S. territories—to find the SMP nearest you, click here.


Countdown to Medicare Part D Open Enrollment: Day 5

Open Enrollment for 2012 begins on Saturday, October 15, and ends on Wednesday, December 7, 2011.

Day 5: Beware of Medicare…Medicare scams that is, this time of year

When Medicare Part D first started in 2006, professional scammers immediately jumped on the bandwagon. They started by devising clever ways to trick seniors into giving them money or other information that would allow the scammers to access their bank accounts. For example, in the “$299 Ring” Scam (see video), callers would identify themselves as Medicare employees and ask for checking account information in order to “sell them a Part D drug plan for $299.”  Other scammers called Medicare recipients and told them they would deposit money into their bank accounts if they provided their account numbers. They would also ask them for their Social Security numbers and threaten them by saying they would lose their Medicare coverage if they did not provide this information.

Fortunately, most people were leery of the callers and notified either the Centers for Medicare & Medicaid Services (CMS) or other local authorities. Many of the calls were traced to phone numbers outside  the United States.

According to CMS, you should always call your local police if you receive a call from an unknown person and are asked to provide personal information over the telephone. Here are some other helpful tips from CMS to keep top of mind, especially during the Open Enrollment period, when professional scammers know you may be searching for a new Medicare plan:

  • Protect your Medicare number. This number is as important as your Social Security number, credit card information, computer passwords, etc. Never give your card or number to anyone—not only is it illegal for someone else to use your card or number, it can lead to identify theft. And if you card is lost or stolen, report it right away to Social Security.
  • If you don’t trust, don’t talk. Only give out your personal information to people or organizations you trust, such as your doctor, trusted friend or family member, attorney, accountant, government organization such as Social Security, or a Medicare-approved plan. (Once you decide to enroll in a Medicare plan—or you decide to switch plans—you will need to provide your Medicare number to the plan.)
  • Never join a plan over the phone—unless you initiate the call.
  • Know the marketing no-no’s. There are many things that Medicare prescription drug plans and the people who represent them cannot do. For example, they can’t:
    • Charge you a fee to join a plan
    • Come to your home uninvited to try to sell you a plan
    • Offer you cash, free meals, or other gifts while trying to sell a plan to you
    • Enroll you into a plan over the phone unless you call them and specifically ask to be enrolled
    • Ask you for payment over the phone or Internet (they must send you a bill)
    • Try to sell you other products other than the plan you agreed to hear about
    • Try to enroll you in a plan during an educational conference or health fair

If you think a plan or plan representative has broken the rules, or you believe you have received a phone call or e-mail from a professional scammer, you should report the incident to Medicare by calling 1-800-MEDICARE (1-800-633-4227);  TTY/TDD: 1-877-486-2048.  Not only will you help CMS to alert others to the scam or tactics, but you will also be playing a very vital role in reducing Medicare fraud.

Tomorrow, I’ll give you some more tips on helping to reduce Medicare fraud, waste, and abuse.

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