Home Health Care Fraud Scams

Scams

From the Office of Inspector General

• Medicare Fraud Schemes  
• Medicaid Fraud Schemes

Articles

• Protecting your Parents from Senior Scams
• FTC on the Health Care Hustle: Some marketers selling medical discount plans try to make people think the plans are health insurance when they're not. They also lie about what their plans really offer. While some plans provide legitimate discounts, others take people’s money and offer little in return. Click here for an FTC site that describes medical discount plans and how you can protect yourself.
• Discount Health Plans Not What They Seem
• Scam Alert: That’s Not Uncle Sam at Your Door Selling an ‘ObamaCare’ Policy
• FBI: Common Fraud Schemes
• Internet Crime Complaint Center (IC3): Claims of being stranded. Falsely portraying themselves to be the victim, hackers use victim's e-mail and social networking accounts to send a plea for money to their contacts.

Scams for Obtaining Medicare Numbers

With so many possible uses of Medicare ID numbers themselves as well as the related Social Security number, a variety of scams have been developed that directly target Medicare beneficiaries in an attempt to obtain and use their Medicare number for 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 then 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 actually 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 the 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 the 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, SSN, or insurance numbers.

Telemarketing/Boiler Room Scams

In Telemarketer/Boiler Room Scams, the telephone is used to obtain Medicare numbers.

• Telemarketing companies identifies specific targets through mailing lists and contacts 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.

$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

NEW  FDA Health Fraud Awareness Video