How Can an Elderly Person Guard Against Healthcare Fraud?

Seniors and elderly individuals can protect themselves from healthcare fraud by taking proactive steps to safeguard their personal information, monitor bills and statements for services, and maintain awareness of common scams. It is estimated that $60 billion is lost annually to Medicare fraud, abuse, and errors which impact access to care and negatively affect finances. The scams associated with heathcare fraud are becoming increasingly more convincing, often posing as fake medical equipment offers or resulting in identity theft and billing fraud. 

Since scammers often claim to be government agents or even healthcare providers, seniors and elderly need to be especially vigilant regarding their Medicare card and number. Unexpected calls, emails, or interactions that demand this information or suggest urgency in providing it should always be recognized as a red flag for a potential scam. Phone calls or emails from individuals claiming to represent Medicare or an insurer should not be responded to without appropriate verification. It is recommended to decline speaking with these unidentified individuals and contact Medicare or the insurance provider using the official numbers or websites provided on the back of the cards. 

Statements or medical bills should generally be shredded after review to avoid identity theft. Prescription labels, insurance forms, and other documents that contain personal information should also be shredded. Billing fraud is a common scam, so Medicare Summary Notices should be reviewed to identify any duplicate charges, unfamiliar provider names, or services that were’t received. If there are any discrepancies, these should be reported. Maintaining a personal record of prescriptions that were dispensed and medical appointments that were attended can be a vital source of information to cross-reference against statements and bills. 

It is also important to maintain awareness of common scams, especially as they continue to change and evolve over time. Unsolicited offers for screenings, medical equipment, or similar services are usually fraudulent billing scams. Legitimate opportunities and programs usually require approval from a physician, so it may be helpful to verify with a healthcare provider about the nature of these unexpected offers. Likewise, unsolicited offers for medication are also a cause for concern; medications should only be purchased from pharmacies to avoid the risk of counterfeit drugs and fraud. 

Taking additional measures such as registering on the National Do Not Call Registry and attending Senior Medicare Patrol fraud prevention workshops are proactive ways to reduce scam calls and maintain awareness. If you suspect that fraud and billing errors have occurred, there are many resources available for additional support. These include contacting Medicare directly, the FTC, HHS Office of Inspector General, and state programs provided by the Senior Medicare Patrol.

Sources

“Medicare Fraud, Errors, and Abuse: How Older Adults Can Protect Themselves”. National Council on Aging. https://www.ncoa.org/article/medicare-fraud-and-abuse-how-seniors-can-protect-themselves/ 

“Health Care Scams Cost Medicare Beneficiaries Billions”. Area Agency on Aging of Central Texas. https://aaact.org/2019/08/08/protecting-seniors-from-health-care-fraud/ 

“Medicare Fraud Scams Target Seniors and Expose Personal Information”. Thomson Reuters. https://www.thomsonreuters.com/en-us/posts/investigation-fraud-and-risk/fraud-scams-targeting-seniors/ 

“5 Ways Seniors Can Protect Themselves From Health Care Scams”. Cigna. https://newsroom.cigna.com/5-Ways-Seniors-Can-Protect-Themselves-From-Health-Care-Scams 

“Protect Yourself and Loved Ones From Medicare Fraud”. Senior Medicare Patrol. https://smpresource.org/