Understanding your medicare benefits can help you identify fraud, abuse, and inappropriate sales practices

You know that understanding your Medicare benefits helps you make informed care and treatment decisions, but did you know it is also the key to fraud and abuse prevention? You, the Medicare beneficiary, with a little knowledge are in the best position to prevent schemes and scams.

Scammers assume lack of knowledge on behalf of the potential victim (that’s you!) for the scam to work. If, for instance, you understand that Medicare requires proof of your INDIVIDUAL medical necessity to pay for an item or service, you would also know that general ads you see on TV or in the newspapers claiming that everyone with Medicare is entitled to a back brace paid for by Medicare are untrue and misleading. A medical professional would have to document YOUR medical necessity for the claim to be properly paid. If your doctor (who knows you and your medical history best) didn’t do that, who did? If you are in need of a service or piece of equipment, you should avoid offerings through advertisements, and instead talk with your personal health care professional.

You might think “what harm could there be in calling the phone number, asking some questions, and gathering some information?” At some point in the future, you will be sorry you made that call. Even if you ultimately decide not to buy/receive the item or service, your phone will continue to ring with offers from that company (and those they have sold your information to) for years to come. And, because of your interest, you have now given them “permission” to call you.

Other examples of mass service provision offers are done more personally by mailing a letter or postcard “invitation” to your home. Scammers may also show up at your housing complex or neighborhood, your senior center, or other places older adults congregate and feel comfortable so often let down their guard. If you are being offered group physical therapy, DNA tests (most often via cheek swab), screening tests out of a van, special shoes, or anything else you didn’t ask for or don’t need, walk away. Even if you don’t have to pay for the item or service, you will most likely be asked to show them your Medicare card (to prove you are eligible for whatever they are offering), which they will promptly use to bill Medicare, often using false medical documentation.

So, how can you help prevent being taken advantage of by these scammers?

– Be careful who you give out your personal information to (name, address, phone, e-mail).

– Never let an uninvited salesman into your home. If you do, make sure your personal papers are put away out of site, and that you have another person with you. Don’t let the salesperson pressure you into a hasty decision.

– Guard your Medicare card (and number) and only show it to legitimate health care professionals at their permanent place of business. (Never use it as ID to enter an educational presentation or event.)

– Be a proactive health care consumer by inquiring about items you need and want. Don’t buy items you have not inquired about and don’t need. Better yet, talk to your health care provider about equipment, tests, or services you think you may need.

Being an informed consumer is the key to preventing Medicare fraud and abuse. Your careful and thoughtful actions could help save precious Medicare dollars that could be used to help you or someone you know. Report suspected Medicare fraud to ND SMP at ndsmp@minotstateu.edu or 1-800-233-1737.

Reprinted with permission from the Colorado SMP.