Medicare Fraud Awareness Month | Fight back against fraud

||| FROM LENA KASSA for ORCAS SENIOR CENTER |||

When 73-year-old Eleanor Simmons received a call from someone claiming to be from Medicare offering “free” genetic testing kits, something didn’t feel right. The caller knew her name and address and just wanted to “verify” her Medicare number. He insisted that immediate action was required to avoid losing benefits.

“They were very pushy,” Simmons recalls, sitting in her sun-drenched living room in Brewster. “When I hesitated, they said my cancer screening coverage would be canceled if I didn’t provide additional information right away.”

Instead of panicking, Simmons hung up and refused to provide any information. She called her local Senior Medicare Patrol (SMP), part of a nationwide network of volunteers helping Medicare beneficiaries identify and report health care fraud. She had just become one of the estimated 2 million seniors targeted annually by Medicare scammers who collectively drain more than $60 billion from the Medicare system each year.

The month of June marks Senior Medicare Patrol Fraud Awareness Month, a nationwide initiative aimed at educating older Americans about the increasing sophistication of healthcare scams targeting them.

“Fraudsters have gotten incredibly sophisticated,” explains Kim McKenna, Coordinator of the state SMP program. “They’re using public information combined with data breaches to create highly personalized scams that can fool even the most cautious seniors.”

The most common Medicare scams currently include:

• Calls offering “free” genetic testing or medical equipment
• Billing for services never provided
• Upcoding legitimate services to charge Medicare more
• Offering kickbacks for referrals or unnecessary services

For Marjorie Davis, 68, awareness came too late. After responding to a “wellness check” at a local shopping center, she found herself billed for multiple expensive tests she never received.

“I just thought I was getting a free blood pressure reading,” Davis says. “Six months later, I discovered Medicare had been billed over $12,000 for comprehensive cardiac monitoring I don’t need and didn’t request.”

SMP volunteers are working to change these outcomes. During this awareness month, Washington state SMP is sharing information, activities, and resources aimed at teaching beneficiaries how to recognize red flags so that they can better prevent, detect, and report health care fraud.

“The single most important thing seniors can do is regularly review their Medicare Summary Notices,” says McKenna. “Those quarterly statements show exactly what Medicare has been billed for under your name. If something doesn’t look right, it
probably isn’t.”

Medicare officials advise beneficiaries to follow these guidelines:

• Never give your Medicare number to anyone calling you unsolicited
• Don’t accept medical equipment or services you didn’t request
• Review your Medicare statements carefully
• Report suspicious activity to 1-800-MEDICARE and your local SMP office

For Eleanor Simmons, her close call turned her into an advocate. She now volunteers with her local SMP chapter, sharing her experience with other seniors.

“Many of us grew up in an era where we trusted authority figures,” Simmons notes. “Scammers exploit that trust. But we’re learning to verify before we trust, and it’s making a difference.”

“It’s not about making seniors paranoid,” McKenna emphasizes. “It’s about empowering them with knowledge and tools to protect themselves and our Medicare system.”

For more information about the national Senior Medicare Patrol Program visit smpresource.org. To contact the Washington state Senior Medicare Patrol, visit this site or call 1-800-562-6900.