Healthcare and Medical Insurance Scams Against Senior Citizens

As outlined in my most recent blog post, senior citizens have become a target group for today’s high-tech, savvy criminals, who do their brand of stealing via the internet. This particular posting highlighted the dangers of identity theft through website, malware and email phishing scams, as well as what our aging parents can learn to do to guard against such online attacks.

Unfortunately, my research on this topic led me to a bevy of other modern-day scams targeting the elderly. So great is this problem that organizations including the FBI, Scambusters and the National Council on Aging now list fraud against seniors as a subsection of its own—an offshoot from other known scams and online criminal activity affecting the majority population.

I’ve decided to dedicate a few successive blog posts to some of these illegal activities in the hopes of saving any of you, adult children with aging parents and those parents who are still actively engaged in your daily activities, from becoming ensnared in just such a scam. This week’s blog post discusses health care and health insurance fraud—including fraud against Medicare.

Our moms and dads grew up in a time when healthcare, and the pace of life in general, was just plain simpler. Physicians had more time to spend with their patients. Solo-practitioners were the norm—the opposite of today’s big-business ownership and accompanying management that seem to be taking over medical practices everywhere. Most important, your doctor’s word was gospel. So when a phone call comes from a person claiming to be a representative from Medicare seeking to verify information to process a claim or send a new identification card, it’s likely that many of our moms and dads will go ahead and do so. Why wouldn’t they?

This very scenario has been successfully playing out in homes across the country, and is currently one of the largest health insurance scams being run today, as senior citizens are being conned into helping these criminals to steal their own medical identities.

Here is a rundown of other such targeted cons for which you and your folks should be on the lookout:

  • “Rolling” lab and testing scams – mobile medical facilities popping up in health clubs, malls, even retirement homes, at which unnecessary and/or phony tests are performed and Medicare and private insurance companies are then billed for services.
  • Medical equipment fraud – “Free” medical products and devices are offered and then billed to the insurer, which pays the claim. The item is then either never delivered to the patient and/or simply not medically necessary. Sometimes the item itself is also a sham and has no curative powers or is made of shoddy—or dangerous—materials.
  • Unethical doctors — and other providers submitting fraudulent claims to the insurer, either for services not performed, services that were unnecessary for the patient, or sometimes simply by submitting fake claim forms and altered bills to the insurer for reimbursement.
  • Medicare fraud – in a class of its own. Fraudulent (and sometimes non-existent) medical facilities—and even some incredibly dishonest citizens—have been known to make off with millions of dollars in Medicare payments submitted with stolen Medicare identification numbers and/or claim forms signed by a brazen physician willing to risk his livelihood.

Here are some suggestions that can help the senior sector avoid getting scammed:

  • Be proactive when visiting a new doctor… verify that this physician is truly Medicare approved through the official Medicare website itself. It’s as simple as any other online search.
  • Review each and every EOB (explanation of benefits) sent to you by your insurer to make sure the services listed match the services performed, and also to be certain that you are the person getting the care being paid for. Medicare identification theft alone cost roughly $10 million annually by some estimates; taxpayers are paying for the loss.
  • If you’re covered by Medicare, be aware that the government is already in possession of your Health Insurance Claim Number (your social security number); they don’t need to verify it—certainly not by phone or email. Hang up the phone or delete the email should you receive such a request. All official correspondence is handled through the U.S. Postal Service. When in doubt, call a customer representative yourself to make certain all is well with your policy.
  • Be selective with the people you allow to review and handle both your medical records and your health care identification information. Only your physician(s) and other medical professionals should be allowed access to these documents.
  • If you have Medicare coverage, be especially wary of “free” offers aimed specifically at this populace (i.e. free services and free products of all kinds, including medical equipment). Often this is a lure to obtain your mom or dad’s health care identification number for illicit purposes.

If you yourself are a senior citizen and are concerned about having been or becoming a victim of healthcare fraud, you should not be afraid to turn to your family for support.

The following link provides excellent information geared specifically to the senior demographic, with volunteer assistance provided by peers:

As always, if I can be of any service to help smooth the pathway of communication between adult children and their aging parents, I am here to offer support and counsel. Please contact me for help.

All my best,

~Rabbi Scott Saulson, Ph.D.

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