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.
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.”
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.
Other red flags for fraud that should raise your level of concern include:
• Suggesting that equipment or services are free and they need your Medicare number for “record-keeping purposes.”
• Saying that Medicare wants you to have the item or service in exchange for your Medicare number.
• Telling you how to get Medicare to pay for the item or service, and all that is needed is your Medicare number.
• Refusing to give you a functioning call-back phone number, or refusing to give you a phone number to call for customer service questions.
• Calling or visiting you and saying they represent Medicare or the federal government.
• Use of telephone or door-to-door selling techniques.
It is a little harder to tell if Web sites and infomercials on television are legitimate. Web sites related to well-known national or local businesses are likely safe. Other indicators include full disclosure of the owner of the Web sites, their address, and a telephone number to call with consumer concerns. As with phone calls, if they offer to give you something for free only after you have given them your personal information, view this as a red flag. “True gifts are free and don’t have any strings attached,” says Ms. Hurme. “If the other end of the string is connected to your personal information or Medicare number, it’s a scam.”
Check with the local Better Business Bureau to see if a supplier is in good standing. Although your state’s Consumer Protection Division or Attorney General probably won’t talk about ongoing investigations, they should be able to tell you if complaints or criminal charges have been filed.
If you have concerns about a phone call or other interaction, report it via the fraud hotline at (800) HHS-TIPS (447-8477) or over the Internet at www.oig.hhs.gov by clicking on the big red button or the photo of a whistle that say “Report Fraud.” Give as much information as you can, including the company’s name, phone number, and address. Caller ID may be helpful in getting some of this information together.
Another step you can take to help prevent fraud is to sign up for the do-not-call list at www.donotcall.gov or by calling (888) 382-1222 from the phone you wish to register. This may help to stop unwanted calls.
“If you are on the no-call list and are still contacted, report them to the Federal Trade Commission via the Web site,” says Ms. Hurme. “This should help cut down on the number of unwanted calls you get.”
She did note, however, that if you have done business with a company in the previous 18 months, it can legally call you. In this case, ask the company to take you off its list; it must then stop calling you.
An indicator that you may be having problems is the arrival of supplies you did not order or need. If this happens, you are under no obligation to accept the package. Refuse delivery, after writing down the return address information, and have it returned to the sender.
While fraud is a major concern, medical identity theft can have other consequences.
“Medical identity theft frequently results in erroneous information being added to a person’s medical record, or even the creation of an entirely fictitious medical record in the victim’s name,” says NHCAA spokesman Michael T. Williams. “Victims of medical identity theft may receive the wrong medical treatment or find that their health insurance benefits have been exhausted. They may unexpectedly fail a physical exam for employment because a disease or condition for which they have never been diagnosed or received treatment has been unknowingly documented in their health record.”
The Office of the Inspector General suggests you check your Medicare Summary Notices (MSN) or your insurance company’s Explanation of Benefits (EOB) even if you don’t suspect fraud. Look for purchases you did not make or did not receive, or instances when what you received is not the same as what Medicare was billed for. This is the health-care fraud equivalent of checking your credit bureau reports. It is often the only way you know if your medical identity has been stolen.
The important area in the MSN is anything entered under “Part B Medical Insurance Assigned Claims.” If you see any charges you don’t recognize, contact the provider to make sure there wasn’t a mistake.
If this does not clear up the problem, you should contact the fraud investigators at the OIG. This can be done using the (800) HHS-TIPS phone number or through the Web site, www.oig.hhs.gov. Again, get as much information as you can to help the investigators do their jobs.
If you have supplemental Medicare insurance or are covered by private insurance, you will get an explanation of benefits (EOB) from your carrier after claims are filed. Look this over carefully to make sure there are no claims for services or equipment that you did not order or receive.
“I cannot stress enough that you are as much a victim of the scam as Medicare,” says Mr. Correira. “Assuming you are not directly involved, you can’t be held responsible for any of the losses. I don’t want someone to be afraid to report fraud because they think they will have to pay for the fraud themselves.”
If you think your medical identity has been stolen you will, quite understandably, be wary of people calling you and saying they are from the government.
“Investigators from Medicare or the State Medicare Fraud Task Force may call you to get more information,” says Mr. Correira. “They will identify themselves by name, title and which office they are from. If they are legitimate, they will already have your Medicare number available. If asked, they can give you a call-back number.”
If all of this looks a little daunting, there are resources available to help walk you through the process.
“Every state has what is known as the Senior Medicare Patrol (SMP),” says Ms. Hurme. “These are volunteer, peer-to-peer counselors supported by federal funding that know how to help consumers with any problems they might have with fraud.”
To find your local SMP, go to www.smpresource.org or call the toll-free number, (877) 808-2468. Other resources include your area Agency on Aging, and many local Senior Citizens Centers will have staff available to help connect you with the local SMP. The Office of the Attorney General in most states has special divisions dealing with Medicare fraud.
There are similar ways to report fraud suspicions if you have private insurance. Call the customer service number on the back of your insurance identification card and ask them how to contact the fraud department. States usually have fraud investigation units, although these tend to be housed within the Department of Insurance instead of the Attorney General’s office. The NHCAA has more information on their Web site: go to www.nhcaa.org, and click on “View Visitor Resources.”
“Untangling the web of problems left behind by medical identity thieves can be a grueling and stressful endeavor,” says Mr. Williams. “The aftereffects can plague a victim’s medical and financial status for years to come.”
Here are some things you can do to lessen your anxiety when buying meters, lancets, and other supplies:
• Ask your diabetes care provider for the names of reliable suppliers.
• Find pharmacies or medical supply shops that are parts of national, regional, or local chains or that have been in business for a number of years.
• Ask relatives, friends, or acquaintances where they get their supplies.
• Some private insurers may have preferred providers that they have vetted and recommend.
• When dealing with someone over the phone or online, get as much information on their location, the name of the owner, and other identifiers as you can, and then confirm them.
“The main things to remember are to never give your Medicare number to anyone until you are ready to actually buy services or supplies,” says Ms. Hurme. “Second, always check the Medicare Summary Notice or insurance company’s EOB to make sure you have received everything that has been billed. Finally, report anything suspicious immediately.”
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