Health Care Fraud Perpetrated Against Senior Citizens

Mar 7th, 2010 | By | Category: Senior Finances

Every family with elderly members has its horror story—or perhaps more than one—about health insurance fraud perpetrated against the seniors.  Most schemes are couched in ‘helping the elderly’ clothing.  Others are just blatant attempts to extort money from unsuspecting victims.  So, as senior citizens, we need to educate ourselves about the schemes out there so we can be better prepared should they come knocking on our door.  As Dr Martin Luther King said in 1963, “Nothing in all the world is more dangerous than sincere ignorance and conscientious stupidity.” 

  • Individuals, and indeed big companies, try to sell medical equipment to seniors who do not need it.  This is particularly the case for walkers and scooters, mobility devices that may or may not be medically necessary.  Some manufacturers advertise ‘free’ products and then charge Medicare and secondary insurance companies for the device.  Some of the items are never even delivered.  Recommendation: Never order such a product from a television ad, newspaper ad or Internet solicitation.  If you think you need a walker or scooter, consult your primary care physician and seek her/his suggestion for where you can purchase the item.  Your physician will give you a “prescription” for what you need, which you will need to take with you to the store where you make the purchase.
  • Unnecessary and sometimes fake medical tests are given to seniors at health clubs, retirement homes, shopping malls and other public places; costs are then billed to Medicare or insurance companies for the fake testing, thus running up the cost of medical care unnecessarily.  Recommendation: Never permit medical testing in public places where you have reason to doubt whether it is legitimate or not.  If you don’t know, call your primary care physician and ask.
  • Medicare and supplemental insurance policies may be billed for services never rendered.  Swindlers change information on bills and sometimes submit fake ones to rob from unsuspecting victims and their insurance coverage.  Recommendation:  Always review your EOB (Explanation of Benefits) reports from CMS (Centers for Medicare Services) and your supplemental insurance policy to be sure the charges are legitimate.  If you see a charge that you did not incur, call the customer care number immediately and report it.
  • Medicare Fraud in particular is extensive and very costly to the American public.  The FBI has this to say about it:  Medicare fraud can take the form of any of the health insurance frauds described above. Senior citizens are frequent targets of Medicare schemes, especially by medical equipment manufacturers who offer seniors free medical products in exchange for their Medicare numbers. Because a physician has to sign a form certifying that equipment or testing is needed before Medicare pays for it, con-artists fake signatures or bribe corrupt doctors to sign the forms. Once a signature is in place, the manufacturers bill Medicare for merchandise or service that was not needed or was not ordered.

Avoiding health insurance fraud is not as difficult as it might first appear.  The FBI has several suggestions SCJ believes worthy of passing on to our readers:

  • Never sign blank insurance claim forms.
  • Never give blanket authorization to a medical provider to bill for services rendered.
  • Ask your medical providers what they will charge and what you will be expected to pay out-of-pocket.
  • Carefully review your insurer’s explanation of the benefits statement. Call your insurer and provider if you have questions.
  • Do not do business with door-to-door or telephone salespeople who tell you that services of medical equipment are free.
  • Give your insurance/Medicare identification only to those who have provided you with medical services.
  • Keep accurate records of all health care appointments.
  • Know if your physician ordered equipment for you.

Next week we will take a look at other kinds of fraud perpetrated against senior citizens.

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