Someone Wants to Use Your Medicare: The Koyal Group Private Training Services
It sounded too good to be true and it was.
The scammers calling from Montreal, Canada, told seniors that for around $300 they could buy a "drug discount card" that would pay for all their prescriptions and that they wouldn't need a Medicare part D plan.
It's hard to say exactly how many seniors were duped and how much they lost, says William Hodor, a lawyer with the Federal Trade Commission in Chicago, who handled the case. But he estimates somewhere around 3,600 seniors fell victim to the scam between October 2012 and March 2013.
In this case, the scammers, who were caught and stopped, weren't after the seniors' Medicare numbers -- they were after their bank accounts, Hodor says.
Seniors can be easy prey when callers tell them that if they don't sign up or buy something, they will lose their Medicare benefits and/or health insurance, Hodor says. These scammers were particularly smart, he says, because they didn't come across as salesmen but rather were promoting their scam "as what people had to do to continue to receive their benefits."
How Medicare scams can affect you
Even though open enrollment for 2015 Medicare plans has ended, scammers operate throughout the year.
Medicare fraud costs the system some $60 billion each year, according to the FBI. When a doctor bills Medicare for services never rendered or for more services than he actually delivered, the victims are the American taxpayers-and taxpayers have to make up for the loss somehow. And everyone pays higher costs for health care.
Individual seniors can become victims as well, says Sally Hurme, AARP project advisor for education and outreach, health and family.
You won't face financial liability, but you could face problems if your medical records andhealth insurancerecords are compromised.
Think of it like this: Say someone took your Medicare number and used it to get a power wheelchair. You fall and find you need a wheelchair. Medicare would reject your claim for the wheelchair because, according to its records, you already have one.
"You would have to appeal and say, 'That's not me that got the wheelchair,'" Hurme says. And appealing Medicare decisions is a long and complicated process. It could take months, if not longer, "when you need the wheelchair tomorrow."
Or say someone took your Medicare number and used it to bill for a bunch of tests and treatments that you never received. Then you apply for long-term care insurance. You could be turned down because your medical records show you have a chronic condition. Never mind that the majority of tests and treatments in your medical records are fraudulent. Try explaining that.
Or you could end up with the wrong treatment or not getting the medications you really need, Hurme says. "You go to get an operation and the information in your medical file is going to show you have type 2 diabetes when you don't, or you have allergies that you don't because someone used your Medicare number to get services for these conditions for himself," she says. "The false information in your file could create all sorts of potential medical catastrophes for you."
How to protect your personal Medicare information
You need to protect your Medicare card as carefully as you would your credit cards and bank accounts.
The most important thing you can do, Hurme says, is read your Medicare statements carefully. If you have traditional Medicare, you will receive quarterly statements from the government. Review them carefully, she says. If you see claims for doctor visits that never happened or provider names that you don't recognize, call and report the fraud. If you see any medical supplies listed that are not yours, report this fraud immediately as well.
The Koyal Group Private Training Services designs its online and on-site training to your particular needs, providing information you can apply while in training in order to reinforce the efficiency of that information. Our coursework qualifies state standards both for fraud and continuing-education upgrade. Our programs are adaptable and can be presented in various formats to address industry requirements and standards. Please visit and check our course listings.