The senior population in the US is on the rise: In 2012, fewer than 20% of the U.S. populace was over 60. But by 2050, people over age 60 are expected to make up 25-29% of the U.S. population.
Seniors are a vulnerable group for scams in general, and even more, targeted by common healthcare fraud scams. Seniors are generationally conditioned to be polite, are often seeking human interaction. They tend to be interested in products promising increased cognitive function, higher energy and stamina, physical conditioning, cancer-preventing properties, and other similar attributes. In a country where medical advances for the treatment and prevention of old diseases have given us hope for a long and fruitful life, it can be believed that the scammers’ products and services can deliver on what they promise.
The main types of healthcare fraud include:
1. Medical Equipment Scams
Medical equipment vendors call to offer “free” products. Insurance companies are then billed for products that were not needed or not even carried out, in the name of the person being scammed.
- Prevention Tip: doing a reverse phone number search after the call can be a reliable way to vet the caller and easily determine if they are scammers.
2. Services Not Performed
Customers or health care providers may bill insurers for services that were not ever provided.
- Prevention Tip: carefully review your and your loved ones’ medical insurance Explanations of Benefits mailings, and call your insurance to report any services you or they did not receive. Keep accurate records of all health care appointments.
3. “Rolling Lab” Schemes:
Illegitimate or unnecessary tests given to seniors at fitness facilities, assisted living facilities, malls or other venues where seniors congregate and then get billed to their insurance companies or Medicare.
- Prevention Tip: utilize a network of trusted medical providers for all medical testing and procedures. Ask your primary care provider about any tests that are offered before accepting, and have them performed at trusted medical facilities.
4. Medicare Fraud
Senior citizens are regularly targeted with Medicare fraud situations, often by medical supply manufacturers who offer seniors free items in exchange for information about their Medicare account. Since doctors have to provide signatures confirming that this equipment or procedure is medically necessary before Medicare pays for it, scammers will go as far as faking signatures or bribing corrupt medical providers to sign the forms. Once these scammers have a signature, the manufacturers might bill Medicare for a product or service that was not needed or even requested. This is a growing problem in the US: in 2017, over 400 defendants, in 41 federal districts, were charged with partaking in fraud schemes that involved about $1.3 billion in false billings to Medicare and Medicaid.
- Prevention Tip: Keep your Medicare card in a secure place, and only provide the card number to trusted health care providers. Do not do business with direct telephone or door-to-door vendors who offer free medical goods or services. Never sign blank insurance claim forms.
How to spot fraud:
It is important to look out for seniors in your family and community and educate them about how to spot health care fraud. Being proactive can help them avoid becoming victims of scams. When an elderly person becomes a victim of healthcare fraud, he or she may be hesitant to report the crime, so reviewing their medical bills and explanations of benefits with them can help. Here are some signs of elder health care fraud:
- Duplicate medical statements/bills
- Evidence of inadequate care in hospitals or nursing facilities
- False use of healthcare information
- Inappropriate billing of services or medical equipment
- Incorrect information on the explanation of benefit paperwork
- Incorrect provider, date, or location of services on health care claims
- The waiving of copayments, coinsurance or deductibles
- Overmedicating or under medicating of patients
- Providing inadequate/substandard care after full payment
- Inadequately trained staff at health care facilities
- Overcrowding at health care facilities
- Response to questions about care, devices or procedures
Final Thoughts
By becoming savvy in recognizing elder health care scams, we can all help avoid and address scams that target our seniors and our health insurance systems. By reporting suspected fraud, we not only help the elder population, but we also help to keep our health care costs from increasing.