Senior Medicare Patrol rep: ‘You have to be extremely careful’ 

KENT, Conn. — The sophistication of fraud is on the rise.

A small group of Kent residents learned valuable tips on how to protect themselves from scams at a Kent Memorial Library program held Thursday, May 22.

Audrey Cole, program coordinator for Senior Medicare Patrol (SMP) from the Western Connecticut Area Agency on Aging, facilitated the discussion about the latest Medicare frauds affecting local communities and offered tips on how to prevent becoming a victim of fraud.

“Ripping off the elderly is big business,” Cole stated at the start of the program. 

Medicare fraud is knowingly and intentionally submitting false claims or making misrepresentations of fact to obtain a federal health care payment for which no entitlement would otherwise exist.

Medicare abuse encompasses any practice that does not provide patients with medically necessary services or meet professionally recognized standards of care.

If an individual suspects fraud or abuse, the first line of action is to report it — immediately, Cole said (important information below).

Cole explained the mission of SMP. It is to empower and assist Medicare beneficiaries, their families and caregivers, and to prevent, detect, and report health care fraud, errors, and abuse through outreach, counseling, and education.

It is difficult to identify the exact number of Medicare fraud cases each year. Many, unfortunately, go unreported. Studies and reports indicate there is significant financial impact.

There’s an estimated $60 billion lost to Medicare fraud annually, and that is only for those cases reported.

She cited one scheme that involves an estimated $2 billion in fraudulent claims for urinary catheters. The alleged scheme involved several companies billing Medicare for catheters that patients were not actually receiving or even requesting.

But not every case is of that size. Some are smaller and can easily be overlooked by a Medicare client. That’s why it’s important for individuals to read the Medicare Summery Notices and Explanations of Benefits.

A scammer who files claims for durable medical equipment, tests or the like using your Medicare number—and those claims having been paid—may mean equipment, tests or the like in the future, may not be covered because services have already been rendered.

Cole said the past week she received 10 new cases, most of which were billing issues. She estimated 30 percent of cases that come across her desk are “out and out fraud right now.” Others may be for improper billing.

She said she once received five complaints about an insurance broker who went door to door attempting to sell Medicare and/or Medicare Advantage plans to residents. When residents questioned the visit, they were told they had just forgotten the appointment.

Cole discussed Medicare ID theft, a popular method of fraud that can occur in a variety of ways and cause major life disruption and lengthy and costly cleanup.

Common signs of identity theft include seeing withdrawals from one’s bank account that can’t be explained; medical providers billing you for a service you haven’t used; not receiving bills and other mail; being denied medical claims because records indicate you reached your benefit limits; not having your health plan cover services because medical records show a condition you don’t have; being notified by the IRS that more than one tax return was filed your name; receiving calls from debt collectors about debts that aren’t yours; and finding unfamiliar accounts or charges on your credit report.

She described multiple incidents involving businesses, such as law offices, that have been scammed by check washing. Fraudsters steal checks, often from mailboxes, and then use chemicals or other means to “wash” the ink off the check. This allows them to alter the name of the payee and/or amount.

“Medicare identity theft is prevalent,” Cole said. “You have to be extremely careful.” 

She emphasized the heightened danger over three-day holiday weekends, like Memorial Day, when most businesses are closed. Scammers have three days they know victims are unable to report potential threats to the proper authorities.

For example, Thanksgiving and Christmas Eve are popular times for fraudsters to make phone calls and attempt to pull identifying information from individuals. These are times individuals and families are preparing for a holiday and are often distracted and more easily able to give out personal information.

“No matter how smart you think you are, people are getting more manipulated,” the program coordinator said. “If you don’t say something, we can’t stop it.”

Cole also explained the importance of not sharing one’s Medicare number. Once a scammer has a Medicare number, someone can fraudulently bill Medicare, sell the number on the dark web, or send an individual a bill for co-payment.

General tips

Important numbers