The National Consumer Protection Technical Resource Center: The Center of Service & Information for SMPs

Health Care Fraud

Scams

From the Office of Inspector General

Top 10 Scams

The National Council on Aging reports that financial scams targeting seniors have become so prevalent that they’re now considered “the crime of the 21st century.” The NCOA is a nonprofit service and advocacy organization representing older adults and the community organizations that serve them. Click here to read an article from the NCOA on its list of the top 10 scams targeting seniors.

Articles

Scams for Obtaining Medicare Numbers

Scammers target Medicare beneficiaries to obtain their Medicare, Social Security, and bank account numbers, which they can use for a variety of fraudulent purposes.

  • Sometimes the Medicare number is simply stolen by an employee at a nursing home, long-term care facility, hospital, clinic, etc. and then sold to organized crime units or gang leaders, who use the information to bill Medicare.
  • In other cases, perpetrators provide an offer for “free services” but require the person’s Medicare number to provide those services.
  • In some instances, scam artists target financially needy individuals and offer to pay them for their Medicare number or pay them to receive services they don’t need.

The Milk/Grocery Scheme

In this scheme, the promoter of the scam may be offering free milk, groceries, or some other product or service. Regardless of the specific product being offered, any scheme following this general process is referred to as a milk/grocery scheme.

  • Promoter visits adult living facilities, senior communities, or government program offices and identifies specific individuals.
  • Promoter approaches consumers and tells them that Medicare, Medicaid, or a private insurance company wants to take care of them or is conducting a provider survey.
  • Promoter gives consumers milk and/or food, cleans their homes, or delivers various equipment and tells consumers that everything is free and provided by the government or a health insurance company.
  • Promoter asks consumers to complete and sign a form proving they were visited. The form asks for Medicare and/or Medicaid numbers.
  • Promoter leaves name and number and guarantees to return to bring more free items. Promoter also solicits names of other potential targets.

Free Medical Evaluations/Testing

The free medical evaluations/testing scheme is similar to the previous scheme, except that in this case, free medical tests or evaluations are offered.

  • Companies use phone solicitation, ads in newspapers, and coupons mailed or delivered to consumer's home to advertise free testing or services.
  • Mobile testing centers frequent shopping malls, retirement communities, fraternal organizations, civic groups, and conventions.
  • Consumer is asked to complete a form to receive free tests.The form asks for Medicare, Medicaid, Social Security, or insurance numbers.

Telemarketing/Boiler Room Scams

In telemarketer/boiler room scams, the telephone is used to obtain Medicare numbers.

  • Telemarketing company identifies specific targets through mailing lists and contacts consumers.
  • Caller uses a high-pressure sales pitch to obtain Medicare, Medicaid, Social Security numbers or private insurance information. Sales pitch deliberately confuses people into believing the caller represents the government or private insurers.

$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 year’s 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.

Arthritis Kit Scam

In this scam, beneficiaries are told if they suffer from arthritis, diabetes, poor circulation, back aches, swelling, muscle soreness, or hand or ankle inflammation that help is on the way with a Medicare-approved arthritis back kit. It’s free to those with Medicare Part A and B, and beneficiaries even qualify for a special heating pad and heat lamp.

This is not true. There is no such item as a Medicare arthritis kit.

SOURCE: Texas SMP

More Information

FDA Health Fraud Awareness Video


Disclaimer