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Avoiding Medical Identity Theft

by Kurt Ullman, RN

Your phone rings, and the caller says that you can get all sorts of free diabetes supplies or a diabetes-friendly cookbook; all you have to do is tell the person your Medicare number. Should you do it?

For many beneficiaries of Medicare, Medicaid, and even private insurance, calls such as this one can result in medical identity theft, fraud, and health-care waste.

“It is really difficult to quantify the size of the problem, since many beneficiaries either don’t notice the fraud or are afraid to tell anyone they have been defrauded,” says Jon-Paul Correira, Assistant Special Agent in Charge of the Boston Regional Office of Investigations in the US Department of Health and Human Services’ Office of Inspector General (OIG). “It is estimated that fraud overall costs the federal programs many millions of dollars every year.”

In fact, the National Health Care Anti-Fraud Association (NHCAA) estimates that tens of billions of dollars are lost each year to health-care fraud.

Red flags
The contacts often come from official-sounding (but bogus) organizations. Callers may say they represent associations with names that sound like real organizations. One common scam is for the caller to say he is from the “National” Diabetes Association instead of the American Diabetes Association. Callers may purposely mispronounce the word “Medicare” so it sounds like Med-E-Care or Med-Uh-Care to confuse the person they are calling.

Many scammers will make statements suggesting they have a special arrangement with Medicare or with your health insurance provider. They may say they can waive co-payments if you work with them — even though doing so is against Medicare rules.

“First of all, Medicare will never make telephone calls offering you supplies or suggesting companies you should use,” says Mr. Correira. “If someone calls you and claims to be from Medicare, that is a red-flag indicator of possible fraud.”

Medicare suppliers cannot solicit a person’s business without first getting permission from Medicare. Mr. Correira notes that getting a call over the telephone doesn’t always mean there is cause for concern, but you should be alert to signs of fraud.

The telephone isn’t the only thing you should be concerned about. “There are sham suppliers of diabetes supplies and other durable medical equipment who are mostly in the business of harvesting insurance identification numbers to file fraudulent claims,” says Sally Hurme, Senior Project Manager of the Health Team for Education and Outreach at the AARP’s Washington, DC, office. “They may be an area storefront, they may operate a booth at a local Senior Fair, or [they may] use other ways to entice people to give them the information they need for their frauds.”

Guard your Medicare number
The single most important thing you can do to help prevent fraud is to guard your Medicare number as you would any other important identifier. You should remember that your Medicare number is usually also your Social Security number, which can open the doors for general identity theft.

“I want to emphasize how important it is to protect your personal information,” says Mr. Correira. “The Medicare number is basically the key to the Medicare program, and it is impossible to commit fraud without it.”

“Don’t let people trick you into revealing personal information by asking to confirm your number,” he continued. “Have them read back to you what they have instead of you telling them. Don’t let anyone ‘borrow’ your Medicare number or other identification for any reason.”

Ms. Hurme suggests that you do not carry your Medicare card with you unless you know you will need it. Instead, make a copy of the card, cross out all but the last four digits, and carry that. If you need emergency medical care, the copy will provide proof of insurance until you can obtain your card.

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Statements and opinions expressed on this Web site are those of the authors and not necessarily those of the publishers or advertisers. The information provided on this Web site should not be construed as medical instruction. Consult appropriate health-care professionals before taking action based on this information.



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