According to the Coalition Against Insurance Fraud, scams against government and private health care insurers form the largest type of insurance fraud – by far. No one knows exactly how much money is lost through health care fraud, but it is likely in the tens of billions of dollars a year, the group claims. In addition, medical identity theft is now one of the top complaints received by the Federal Trade Commission, CNBC reports.
Government insurance, including Medicare, is a frequent target. Indeed, scammers are using this year's newly issued Medicare ID cards as a way to steal identities. The new cards replace Social Security numbers with randomly generated, 11-character numbers. Scammers posing as Medicare officials are asking people to pay for the new cards, which are in fact free. Or they are calling people to say they have a refund coming and need the ID number and a bank account number to deposit it. These, and many other Medicare scams, are used to steal money or the person's identity and use it for their own medical care or sell it on the black market.
Billing fraud is another huge problem, and it's not always easy to tell what is legitimate and what isn't. "There can be confusion about services that are being billed for, and it is hard to parse out if it's fraud or a billing error," says Fred Riccardi, vice president of client services at the Medicare Rights Center. Fortunately, there are many resources to help.
The Centers for Medicare and Medicaid Services lists numerous tips for preventing fraud on its website. Some of the most critical include:
- Protect your Medicare and Social Security numbers and treat your Medicare card like it's a credit card. Don't give your Medicare card or number to anyone except your doctor or people you know should have it.
- Remember that nothing is ever "free." Don't accept offers of money or gifts for free medical care.
- Educate yourself about Medicare. Know your rights and what a provider can and can't bill to Medicare.
- Be wary of providers who tell you that the item or service isn't usually covered, but they "know how to bill Medicare" so Medicare will pay.
- Always check your pills before you leave the pharmacy to be sure you got the correct medication, including whether it's a brand-name or generic and the full amount. If you don't get your full prescription, report the problem to the pharmacist.
Robocalls are a big problem. "I get four or five a day," says Tatiana Fassieux, a consultant with California Health Advocates, a Medicare advocacy organization. "Don't succumb to those free back and knee brace offers. You may not get what you really need because your doctor is not involved, and also it is an open door to having whoever is doing this to continue submitting claims that the individual hasn't gotten or needed."
Also, beware of marketing approaches by insurance plans and agents. "No door-to-door solicitation is allowed for Medicare plans," Fassieux says. And don't believe it when an agent or broker claims he can get you a better deal. "All rates are fixed and filed with the government," Hakim says. "Whether it's an agent or a carrier, you cannot get a better rate with someone over another."
