Senior Medicare Patrols (SMP) are projects that provide resources and counseling to help counter Medicare fraud, correct errors, and respond to abuse. SMPs help educate and empower Medicare beneficiaries in the fight against health care fraud. Your SMP can help you with your questions, concerns, or complaints about potential fraud and abuse issues. It also provides information and educational presentations. Colorado’s SMP can be reached at https://doi.colorado.gov/insurance-products/health-insurance/senior-health-care/medicare/senior-medicare-patrol-smp-medicare or by calling 800-503-5190.
Among prominent recent frauds SMPs have alerted consumers to are the following three:
As the number of people and communities affected by the COVID-19 pandemic grows, so do the scams associated with it. Scammers use public health emergencies as opportunities for new fraud schemes. Because older adults are at greater risk for serious illness from COVID-19, they may target older populations. It’s important to remember that although the Centers for Disease Control and Prevention (CDC) and other public health officials may contact you if they believe you may have been exposed to the virus, they will not need to ask you for insurance or financial information.
Scammers rapidly alter their tactics and adapt their schemes to the changing landscape, and have leveraged the COVID-19 vaccine, testing sites, and testing kits to prey on unsuspecting beneficiaries. Be vigilant and protect yourself from potential fraud concerning COVID-19 vaccines, testing, and treatments.
Things to know about COVID-19 vaccine scams:
- You likely will not need to pay anything out-of-pocket to get the vaccine at this time.
- Medicare has not issued a COVID-19 Medicare card and anyone contacting you about this is attempting to steal your information. Medicare will not contact you by phone to confirm your Medicare number.
- No one from a vaccine distribution site or health care payer, like a private insurance company, will call you asking for your Medicare number, Social Security number, or your credit card or bank account information to sign you up to get the vaccine.
- Note that the administration of the COVID-19 vaccine will be billed through Original Medicare, even if you are on a Medicare Advantage Plan. This means you may need to provide your Medicare number when getting the vaccine at public venues where they wouldn’t already have your Medicare number.
- Buying a vaccine card or making your own is unauthorized use of an official government agency’s logo or seal, and it is a crime.
Things to know about COVID-19 testing schemes:
- Be cautious of any COVID-19 testing site that requires your financial or medical information in order to receive a free test.
- Be mindful of advertisements for COVID-19 testing or treatments on social media platforms. If you make an appointment for a COVID-19 test online, make sure the location is an approved testing site. You can check official government websites to confirm approved testing sites.
- Be careful of scammers selling fake and unauthorized at-home COVID-19 test kits in exchange for your personal or medical information. Purchase or order only FDA-approved COVID-19 test kits from legitimate providers. Colorado has provided FREE test kits. Check https://covid19.colorado.gov/testing to learn more.
- Be suspicious of anyone going door-to-door to offer free coronavirus or COVID-19 testing, supplies, treatments, or vaccines. These could be attempts to steal your medical/financial information.
- If you go to a pop-up site or other testing facility, research the facility or testing site before you go. Contact your local health department to find a legitimate test site near you.
- Ignore offers or advertisements for COVID-19 testing or treatments on social media sites.
- Be cautious of COVID-19 survey scams that ask for personal, medical, or financial information.
Genetic testing fraud
Across the nation genetic testing company representatives are offering “free” genetic tests to Medicare beneficiaries. These tests can also be referred to as DNA screenings, cancer screenings, and hereditary testing, to name a few. The representatives go to senior centers, senior housing, health fairs, and even parking lots to convince people to let them take a cheek swab for testing. They advertise on TV and online. They promise that the results will help recipients avoid diseases or find the right medications. All they ask for in return is the person’s Medicare number.
It may sound harmless, but it’s dangerous. These companies can steal people’s medical identity and falsely bill Medicare, draining the system of needed funds. Tests ordered under these circumstances are unnecessary and could lead to confusion about someone’s health condition.
Because confusion exists regarding Medicare’s coverage for genetic tests for cancer and other conditions, the Office of Inspector General (OIG) released a fraud alert on the topic. It advises the public to be suspicious of anyone who offers free genetic testing and then requests their Medicare number.
The OIG’s fraud alert also states that only a physician you know and trust should approve any requests for genetic testing. This should be a physician who is already seeing and/or treating you. A doctor who has never met or examined a patient, often hired by a genetic testing company, should not be signing off on any tests. That’s a red flag.
The SMP recommends that beneficiaries should:
- Refuse to give out your personal information or accept screening services, including a cheek swab, from someone at a community event, a local fair, a farmer’s market, a parking lot, and/or any other large event.
- Go to your own doctor to assess your condition, not a doctor on the phone you’ve never met from a company you don’t know.
- Always read your Medicare Summary Notice (MSN) or Explanation of Benefits (EOB). The words “gene analysis” or “molecular pathology” as service codes may indicate questionable genetic testing.
- Refuse the delivery of any genetic testing kit that was not ordered by your physician.
- Be suspicious of anyone who offers free genetic testing and then requests your Medicare number.
Hospice fraud is largely unreported and can cause direct patient harm if undetected. The term “hospice fraud” covers a variety of different types of fraud that are each detrimental in their own way. Fraudsters are targeting assisted living facility and nursing home residents whose life expectancy exceeds six months and are using high-pressure and unsolicited marketing tactics to get them to agree to hospice services.
Hospice fraud is potentially more dangerous for beneficiaries because hospice care provides palliative care only. This means the focus of care switches from curative care (treating the illness) to comfort care (quality of life). For example, when a beneficiary is receiving chemotherapy treatment for cancer and their coverage switches to hospice, the chemotherapy is no longer a covered treatment as it is a curative treatment. While the beneficiary can discontinue their hospice benefit at any time, this may prove difficult if they are dealing with a fraudulent hospice enrollment. While waiting to be disenrolled, the inability to receive lifesaving or curative treatment could be detrimental for the beneficiary.
Other dangers of hospice fraud include:
- Receiving inadequate or incomplete services from a hospice worker. This can include having no skilled visits in the last week of life or providing less care on the weekends and disregarding a beneficiary’s care plan.
- Embezzling, abusing, or neglecting beneficiaries.
- Medication theft by a hospice worker.
- Enrolling someone in hospice without the knowledge or permission of the family or other pertinent party.
- Falsely certifying or failing to obtain physician certification on plans of care.
- Providing gifts or incentives to encourage beneficiaries to elect hospice even though they may not be terminally ill.
- Billing for a higher level of care than needed or provided or for services not received.
The SMP recommends that beneficiaries should:
- Be sure your doctor has assessed your condition.
- Be sure your doctor has certified that you are terminally ill and expected to live six months or less.
- Never accept gifts in return for hospice services and be wary of “too-good-to-be-true” offers.
- Report quality-of-care complaints to your local SMP and the Beneficiary and Family Centered Care-Quality Improvement Organization (BFCC-QIO) (qioprogram.org/file-complaint).
Once again, your SMP can help you with questions or concerns about potential fraud and abuse issues. Colorado’s SMP can be reached at https://doi.colorado.gov/insurance-products/health-insurance/senior-health-care/medicare/senior-medicare-patrol-smp-medicare or by calling 800-503-5190.