As public interest attorneys, many of us represent clients who have Medicare and/or Medicaid as health insurance. Did you know that Medicare and Medicaid fraud is a $60 billion per year industry?
The best way to reduce fraud is through education and outreach to beneficiaries. In 1997, the federal government started a pilot of the Senior Medicare Patrol (SMP) program to increase beneficiary awareness and reporting of fraud. Since then, the program has expanded to 54 SMP grants – one in each state as well as the District of Columbia, Puerto Rico, Guam, and the Virgin Islands.
The Senior Medicare Patrol grants focus on educating Medicare beneficiaries about the signs of Medicare fraud and what to do if fraud is suspected. In June 2018, the Greater Wisconsin Agency on Aging Resource (GWAAR) was awarded the Senior Medicare Patrol grant under a five-year contract.
Current Medicare Scams
Current scams include:
Companies targeting senior centers or senior housing complexes and offering “free” DNA testing or cancer screening at an ice cream social event. During the event, individuals are asked to swab their cheek to collect a sample to be sent to the lab for analysis. They are then told the test will be completely covered by Medicare as a preventive service as long as they provide their Medicare number.
Companies alleging to be durable medical equipment suppliers call Medicare beneficiaries to notify them that their doctor has prescribed a back, knee, or wrist brace for them. If the beneficiary questions the need for the item, the caller threatens to report the beneficiary as noncompliant with medical treatment and “turn off” their Medicare benefits.
Some hospice companies have enrolled Medicare beneficiaries in hospice even though the beneficiaries are not sick and do not have a terminal illness. The companies approach people in senior housing complexes and tell them that they are simply signing them up for free Medicare benefits such as someone to clean their house and prepare their meals. The company then bills Medicare each month for hospice services, but never provides any service to the beneficiary.
Individuals calling Medicare beneficiaries on the phone and alleging to be from Medicare, Social Security, or the IRS and demanding bogus payments, bank account information, credit card information, Medicare numbers, or personal information. These are always scams as Medicare, Social Security, and the IRS will never call beneficiaries.
Responding to Medicare Scams
What should Medicare beneficiaries do if they receive a phone call or believe they have been victim of a scam?
do not provide or verify any personal contact information, including a Medicare number, or any other information the caller may already have;
hang up immediately;
write down the caller’s phone number if they have caller ID;
write down the company the caller says they work for; and
call the Wisconsin Senior Medicare Patrol (SMP) help line at (888) 818-2611 to report the call. The SMP will report this fraudulent activity to both Medicare and the federal Office of Inspector General.
In addition, it's a good idea for beneficiaries to review all quarterly Medicare Summary Notices (or Explanation of Benefit statements) to be sure nothing was fraudulently billed under the Medicare number.
If a beneficiary's Medicare number has been compromised, they should call 1-800-MEDICARE or the Senior Medicare Patrol to request a new randomized Medicare identification number.
Assisting Your Clients with Medicare Fraud
If you or your clients have reason to suspect Medicare fraud, errors, or abuse, contact the Wisconsin Senior Medicare Patrol (SMP) at:
GWAAR is also seeking SMP volunteers in all 72 counties and tribes to assist with Medicare outreach and beneficiary educational events. Check out our website for more information.