‘That’s where the money is!’: Increase in Medicare-related fraud

By Elliott Greenblott
From the 1920s to the 1950s, Willie Sutton was one of the most successful criminals in the United States. As an individual on the F.B.I.’s Ten Most Wanted list, Willie made over $2 million in illegal bank withdrawals — robberies.

Falsely attributed to Willie is a response to a newspaperman asking him why he robbed banks.

“That’s where the money is!”

While he may never have made the comment, it bears a lot of truth, even in this era, as a motivation for financial crimes. Given a rapidly growing senior population, there is a clear increase in Medicare or Medicare-related fraud.

Evidenced by the deluge of advertising, we are in the middle of “open enrollment” for Medigap and Medicare Advantage programs. Con-artists are aware of this and will attempt to profit through any confusion or deception.

As a massive program, it takes little effort to see why the national bill for Medicare fraud exceeds $60 billion annually; a number that does not include the money lost by individuals and organizations to Medicare-related fraud that extends to private Medigap and Medicare Advantage programs.

Medicare fraud occurs in bills for services not provided, enrollee claims for services or equipment not received, and overcharges.

There are clear signs that fraud is being attempted. Medicare will never contact you for your Medicare number or personal information without prior written approval. Medicare will not sell you anything nor require payment of fees for services by phone or email. You will not receive notification by phone or email of expiration of benefits or the need to reapply to receive benefits. Note the caller ID of any phone call or the email address of any sender. Callers often use fraudulent local phone numbers or email addresses that attempt to disguise the true identity of the sender. Finally, note any details from any call or email claiming to originate with Medicare and report the contact. Online, you can go to www.Medicare.gov and enter the word “fraud” in the search line or call 1-800-MEDICARE 1-800-633-4227.

In addition, each state has a Senior Medicare Patrol (SMP) program to assist recipients: New Hampshire 866-634-9412, Vermont 800-934-4790.

Much of Medicare fraud is not reported. In part, this is due to the fact that benefit recipients ignore the fraud unless there is a personal loss. The cost is to Medicare, not the individual.

The reality: Medicare fraud bears a cost to everyone. Higher premiums paid from payroll taxes, reduced Medicare benefits to those on Medicare, and increases to the National Debt are a few examples. While much of the fraud occurs behind the scenes, some is very easy to detect. As a Medicare enrollee, you receive regular notice of benefits paid in your name. Review these notices for any charges for services or supplies you did not receive or request and report the crime to Medicare or to SMP as previously noted. Report or disregard any offers of “free” braces from Medicare.

Beyond the world of Medicare lies benefits purchased as Medigap supplemental or Medicare Advantage programs offered by private insurance companies.

Medigap insurance provides coverage as a supplement to the original Medicare program by assisting with the portion of costs not addressed by Medicare.

Medicare Advantage programs replace the traditional Medicare program with an insurance policy that may cover a wider range of services at a lower cost. Often, Medicare Advantage programs limit subscribers to obtain services from “network” providers, doctors, hospitals, pharmacies that are under contract with the insurance company. Out-of-pocket costs, fees, premiums, coverage levels and services provided can vary greatly and require subscribers to research options.

Also, Medigap and Advantage programs require State registration. If you have questions about any offers, contact your state financial regulators or attorney general’s office and verify that the offer, company, and agent are registered.

Policy change can be done with minimal disruption to services but keep in mind that “open enrollment” ends on Dec. 7.

Questions, comments, concern? Contact me at [email protected].

Elliott Greenblott is a retired educator and the Vermont coordinator of the AARP Fraud Watch Network. He produces a feature CATV program, Mr. Scammer, distributed by GNAT-TV in Sunderland, VT.