Healthcare Fraud and Scams:
The Impact on Elders
CARIE and The Pennsylvania Senior Medicare Patrol
• CARIE, the Center for Advocacy for the Rights and Interests
of the Elderly, is a private, non-profit organization that has
been dedicated to improving the well-being, rights and
autonomy of older persons through advocacy, education,
and action since 1977.
• In 1997, CARIE received the grant to be the SMP for the
state of PA. The mission of the Senior Medicare Patrol is to
empower elders to protect themselves against health care
fraud, scams, and abuse.
• There are SMP fraud prevention programs in every state,
District of Columbia, and U.S. territories.
The Impact of Fraud and Abuse on Beneficiaries
Healthcare fraud is not just about the government losing
money…
• Beneficiaries can become victims of identity theft, have their
good credit damaged, have their bank accounts cleaned
out, and incur large out of pocket expenses like lost wages,
legal fees and other charges
• People can also lose access to care, be denied necessary
care, suffer inappropriate or low quality care, lose benefits,
get stuck with bad equipment, the wrong drugs or other
things they don’t need.
What Does Healthcare Fraud Look Like?
A short list:
• Theft and use of a beneficiary’s Medicare card/number
or bank account information
• Scammers obtaining personal information through
deceptive means
• Scammers paying beneficiaries kickbacks/bribes for use
of Medicare number
• Providers billing for services or supplies never received
Case Examples From Around the Country
$299, $389 or $399 Scams
•
•
•
•
•
In these types of scams, Medicare numbers are not the only goal. The
scammers also obtain the beneficiary’s bank account information and
use it to take as much money as possible directly from the beneficiary.
Telemarketers/individuals identify themselves as a Prescription Drug
Plan.
Caller offers a Prescription Drug Plan that will provide a one year
supply of prescription drugs for one payment of $299, $389, or $399.
The beneficiary is told payment can only be made by automatic
withdrawal. The beneficiary is asked for his/her Medicare and/or
Medicaid and bank account numbers so the plan can start the first of
the month.
The money is withdrawn with no prescription drugs delivered, or the
bank account is cleaned out.
Case Examples From Around the Country
Telemarketing/Boiler Room Scams
• In Telemarketer/Boiler Room Scams, the telephone is used
to obtain Medicare numbers.
• Telemarketing companies identify specific targets through
mailing lists and contact consumers.
• Caller uses a high-pressure sales pitch to obtain Medicare,
Medicaid, SSN, or private insurance information. Sales
pitch deliberately confuses people into believing the caller
represents the government or private insurers.
Case Examples From Around the Country
A fake “Veterans Affairs” organization that is
not affiliated with the Federal government
misleads veterans into providing personal
information.
Case Examples From Around the State
Philadelphia, southern New Jersey, and Delaware
A caller to the PA-SMP reported a durable medical
equipment provider that was dropping off scooters to
people in exchange for Medicare numbers. The
caller refused the scooter and threatened to call the
police. Despite her refusal, the provider still
managed to get her Medicare number and billed
$5000 for a scooter. The provider is currently under
indictment due to an FBI investigation.
Case Examples From Around the State
Allegheny county
The SMP was alerted to a scam in Allegheny County.
A woman identifying herself as a Medicare employee
called a Medicare beneficiary on the telephone. The
caller said that she needed to come to the
beneficiary’s home and have her sign some papers.
The caller claimed this was a new program in
Medicare.
Case Examples From Around the State
Philadelphia County
1. Scammers who claim to work for Medicare call Medicare beneficiaries
and say that they need to come to the beneficiary’s home to talk about
benefits the person may not know about.
2. A consumer in Philadelphia recently reported being called and offered
a new medical card that would give him free health care. The scammer
who contacted the consumer did not identify himself or his organization.
There was no mention of Medicare during the conversation. However,
the scammer knew the consumer’s address and the name of his bank.
The only information the scammer asked for was the “bank location”
number which the scammer said appeared at the top of the bank
statement just below the date.
Case Examples From Around the State
Potter/Tioga/Luzerne/Wyoming counties
People identifying themselves as Social Security
employees are calling Medicare beneficiaries on the
telephone and stating that the beneficiary needs a
new Social Security or Medicare card. The caller
then asks the beneficiary for his or her bank account
information.
Case Examples From Around the State
York County
Scammers claim to be from the Social Security Administration
(SSA). The representative told the senior that the SSA was
issuing new medical ID cards. These new cards are to be used
with the existing red, white, and blue Medicare cards, not as a
replacement. The rep explained that the senior must have both
cards in order to receive care.
To receive the new card, the senior was asked to provide her
bank account number. The fake SSA rep already had her name,
address, telephone number and bank routing number.
The senior was told that if she did not provide her bank account
number, she would not be able to use her Medicare, and she
would stop receiving Social Security.
Case Examples From Around the State
Philadelphia County
Elders in several subsidized housing buildings in
Northeast Philadelphia were solicited with bribes to
accept in-home care services that they did not need.
Their Medicare numbers were used to submit huge
numbers of claims for unnecessary (some from
unqualified personnel) and often never-provided
services.
These beneficiaries were also at risk of fraud and
abuse by the individuals coming into their homes, as
many “aides” were simply relatives or friends of the
agency’s workers.
What You Should Know To Help Your Clients
• Consumers should not give out any personal information to
someone who has contacted them. Social Security,
Medicare and bank account numbers can be used against
beneficiaries as can information such as the names of
children or grandchildren.
• Beware of people who say they are from an organization
such as Medicare and they need to know the beneficiary’s
Medicare number. If they truly were from Medicare, they
would not need to ask. Nor would they call or visit
someone’s home unless the beneficiary called them first.
What You Should Know To Help Your Clients
• Beneficiaries should never give any personal information
(Medicare or bank account numbers, birth date) to callers
or people who show up at their door. Encourage clients to
hang up on someone who tries to get personal information
from them.
• Beneficiaries should always rely on their personal doctors
to recommend all medical services and equipment for them
and never allow anyone to convince them to contact their
doctors to request a service they do not need. Don’t
accept equipment from people who call or show up at the
door.
• Medicare and Social Security will never try to sell a
service or product.
What You Should Know To Help Your Clients
• Never sign blank insurance claim forms or contracts
• Do not provide or verify social security or bank
information over the phone, unless the beneficiary has
initiated the call (e.g. calling SSA to get information)
• After reviewing Medicare Summary Notices and Part D
Explanation of Benefits, shred the documents when they
are no longer useful
• Don’t keep mail in the mailbox for long periods of time
• Get on the Do Not Call list: www.donotcall.gov
Where To Report Healthcare Fraud
• Pennsylvania SMP: 1-800-356-3606
• Medicare: 1-800-MEDICARE (1-800-633-4227)
• HHS Office of Inspector General: 1-800-447-8477
• Federal Trade Commission’s ID Theft Hotline:
1-877-438-4338
• State Attorneys General
• State Insurance Commissioner
• Your Area Agency on Aging’s Adult Protective
Services department
Pennsylvania SMP
Contact information for Pennsylvania
Pennsylvania SMP at the
Center for Advocacy for the Rights and
Interests of the Elderly (CARIE)
100 S. Broad St. Ste. 1500
Philadelphia, PA 19110
215.545.5728 or 1.800.356.3606
www.carie.org
Visit CARIE’s website to sign up for CARIE’s newsletter
and join us on Facebook and Twitter
Thank You
Any Questions?