The government spent nearly $950 billion on Medicare funding in 2022, according to the Centers for Medicare and Medicaid Services. According to some estimates, scammers claim around $60 billion of funds.
A rip-off can start with a simple call. Read on for what consumers should avoid.
CONSTANT CALLS
“I get multiple calls every day,” Ellen Saler-Santini told NBC 5 Responds.
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Often, the person on the line offers help with Medicare benefits.
“Asking me if I have received my benefit card and my food card for Medicare,” Saler-Santini said.
Saler-Santini doesn’t buy it. For good reason
“I am a retired RN case manager so I'm really familiar with how to find my benefits,” said Saler-Santini. “When I have questioned some individuals, they've just hung up on me.”
The Centers for Medicare and Medicaid Services explain CMS won’t call to sell you anything or visit you at home. Medicare won’t call unless you reach out and request a callback. A Medicare health or drug plan may call you if you’re already a member of the plan. Beware of unsolicited calls asking you to confirm your medical information.
According to a consumer alert from the U.S. Health and Human Services, callers are after a key piece of information: your Medicare number. With it, someone could bill Medicare for something an enrollee didn’t receive or wasn’t prescribed by their doctor.
EQUIPMENT BILLED
Linda Hennis spotted $15,000 worth of catheters she didn’t need or order on her Medicare Summary Notice. Hennis reported it to Medicare. Though she wasn’t billed directly, Hennis told our NBC 5 Chicago colleague, PJ Randhawa, there could be consequences later.
“If your Medicare's billed for a device or equipment at some point and paid for and then later on, you legitimately need that, they can deny it,” Hennis said.
The Centers for Medicare and Medicaid Services tells us, in part, that CMS does not confirm or discuss the existence of any ongoing investigation.
In early 2023, CMS said it attributed a “concerning rise” in urinary catheter billings to 15 Durable Medical Equipment, Prosthetics, Orthotics and Supplies supply companies. It said CMS determined people with Medicare did not receive the catheters, their doctors didn’t order them and the catheters were not needed. CMS said it used fraud prevention tools to suspend and stop most of the payments.
CMS also noted if something is marked “payable” on a Medicare Summary Notice, it doesn’t mean funds will be paid. CMS may withhold payment to investigate. It also said it takes seriously its responsibility to protect Medicare trust fund dollars against fraud, waste, and abuse.
PROTECT MEDICARE NUMBER
FTC attorney Erica Hilliard said consumers should review their summary notices and look for unusual or unexpected charges. Be skeptical of anyone contacting you about benefits even if they already have some of your information, like your Social Security number.
“They know just enough information to make the consumer feel comfortable that they must be with the Medicare or Medicaid entities. And they're not,” Hilliard said.
Consumers may receive a call, text or see an online ad offering free supplies or gift cards. Someone may contact a consumer and threaten to cut off benefits or insist the consumer needs a replacement card. Hilliard said to hang up on unsolicited calls and contact 1-800-MEDICARE (1-800-633-4227), the phone number listed on the Medicare.gov website.
“There's not some secret program out there that the government is not making available to everyone. If it's not available on the website, if you can't call through the .gov phone number to secure access to those products, then they're not coming from a legitimate source,” Hilliard explained.
CMS said consumers should protect their Medicare card the same way they’d protect their credit cards. Don’t provide your Medicare number to anyone except your doctor, insurer or someone you know should have it.
“You have to guard that like you guard your Social Security number,” Saler-Santini said.
As for the calls?
“At this point, I don’t answer.”
Keep records of medical services you get. If you see a charge on your Medicare summary statement or an explanation of benefits statement that you don’t recognize, contact your provider.
REPORT SUSPECTED FRAUD
If you suspect fraud, call 1-800-MEDICARE or report it here.
If you have a Medicare Advantage Plan or Medicare drug plan, you can also call the Investigations Medicare Drug Integrity Contractor at 1-877-7SAFERX (1-877-772-3379).
