Protecting Against Medicare and Consumer Fraud

Presenter: Margene O’Leary, Aging Resources of Iowa

 

The consumer and fraud protection arm of Medicare started in 1997 as Senior Medicare Protection as a way to make sure Medicare was being properly used.  It was an outgrowth of the frustrations of a Waterloo woman who was required to receive two flu vaccines because the first was determined to be from an ineffective batch.  Both immunizations were billed to and paid for by Medicare.  Her complaint to Senators Tom Harkin and Charles Grassley and others resulted in the reimbursement of Medicare by the pharmaceutical company for the amount of $1.6 billion dollars, and the birth of Senior Medicare Protection (SMP).

 

The purpose of SMP is three-fold:  Protect, Detect, and Report.

Protect the consumer: 

  • It is important for people to protect their Medicare number.
  • Don’t give you Medicare number out to anyone other than your care provider, and give it in person if at all possible. 
  • Never give your Medicare number out over the phone because it can lead to identify theft.  Medicare always asks for information via the mail, never by phone.
  • Check your quarterly Medicare summary notices to make sure that all your identification information is correct and that every medical charge is correct.
  • Keep your quarterly Medicare summary notices for at least 3 years, then shred or burn them to protect your information from falling into the hands of the unscrupulous.

 

Detect errors, fraud and abuse:

  • Check the information on your Medicare Drug Plan Part D monthly statement each month for accuracy and to make sure you have received all the medications that appear on the list in the amounts listed.
  • Watch for double billing on your Medicare report, that is, billing for the same service twice.  However, if your physician office made a mistake on the first claim, they can resubmit without penalty.
  • Call Medicare at 1-800-633-4227 (the best time is late evening or during the night, anticipate a long wait otherwise) to receive a PIN number, and check www.MyMedicare.gov to periodically check your Medicare account for accuracy.

 

Report errors, fraud and abuse:

  • If you find an error on either the Medicare or the Medicare Part D reports, report it.  You can call Medicare at 1-800-633-4227 (the best time is late evening or during the night, anticipate a long wait otherwise) or SHIPP at 1-800-351-4664 if you need to call on behalf of a family member.
  • Investigations are underway for fraud and abuse by insurance companies and providers in Long Term Care insurance and in Medicare Part D (drug program ).

 

Elder Iowans are at particular risk for identify theft, scams and fraud of various types because Iowa has a very large percentage of elders over the age of 85, compared to other states in the nation.  Con artists know this is ripe for the pickings.

  • Be very careful to guard  your personal information.  Do not give it out over the phone to someone who calls you attempting to “verify” personal information.  Secure your social security card and other identification where it cannot be pick pocketed or stolen.
  • Don’t carry more credit cards than what you need for a specific shopping trip, then make sure they are always in your sight.

 

SHIPP (1-800-351-4664 ) can help you calculate the best provider for your Medicare Part D, just call them.  You need to review your Part D provider each year and re-enroll annually between October 15 and December 31 ANNUALLY.

 

As a caregiver, if you have financial power of attorney for your loved one with Alzheimer’s disease, you can do several things to protect your loved one and yourself from unscrupulous sales people:

  • Ask your local post office to have your 3rd class mail held back
  • Change you phone number to an unlisted number, and make sure that number is given only to those who absolutely have to have it.
  • List your number on the Federal Do Not Call list (this will not prevent non-profit organizations or political organizations from calling, though)
  • Refuse delivery or installment of any material ordered by your loved one, and refuse to pay.  If the caller is persistent, explain that your loved one has Alzheimer’s disease and is incompetent to engage in a contract for services.  If the seller persists, refuse to pay and call the State Attorney General’s office and report the offense.
  • Call the offending company and ask to have your family member removed from the call list.

 

Note of interest:

Principal Financial Group hosts a website with information about drug interactions.  www.principal.com, go to the section on Health.  Follow the directions and enter all your prescription medications and supplements.