Louisiana Blue encourages seniors to stay alert during Medicare Fraud Prevention Week

As Medicare Fraud Prevention Week (June 1-5) raises awareness about healthcare scams targeting older adults, Louisiana Blue is educating senior citizens and their families about different forms of Medicare fraud, warning signs and why reporting suspicious activity matters.

“Anything that doesn’t seem right probably isn’t right. Anything that has a sense of urgency – asking you to pay something or provide personal information immediately – is definitely a problem,” said Kandyce Cowart, Louisiana Blue Special Investigations Manager. “The easiest way to avoid getting involved in a scheme is to never engage. Don’t answer calls from unknown numbers. Don’t open the door to strangers. It’s okay to be rude.”

Cowart explained some of the most common Medicare fraud schemes:

1. Phantom provider billing

This often begins when fraudsters obtain Medicare beneficiary information via data breaches. They then create phantom companies and use the stolen beneficiary information to bill for unnecessary durable medical equipment, which are things like braces or mobility assistance devices.

“This scheme heavily impacts the Medicare supplement insurance plan population to the tune of millions of dollars a year,” Cowart said. “The only way a recipient knows about the fraud is if they see it on legitimate documents, such as an explanation of benefits or a notice that a claim has been paid on their behalf. Our amazing Louisiana Blue team has been catching this fraud very early and has put measures in place to prevent it, but in many instances, Medicare has unfortunately already paid these fraudulent claims.”

2. Taking advantage of misdials

Cowart said fraudsters often purchase phone numbers that are very similar to legitimate numbers for Medicare or insurance companies. When a Medicare member misdials – sometimes being off by just one digit – they reach bad actors who are ready to take advantage of them. Not only can that lead to people unwittingly sharing personal financial and medical information with fraudsters, it can also unleash a wave of scam calls.

“We recently had a member tell us he misdialed and ended up giving some bad actors his personal information,” Cowart said. “After that, he started receiving fraudulent calls from people claiming they were from Louisiana Blue and/or Medicare. Once these bad actors have your name and information, any type of scam can come your way.”

3. Diabetic testing supplies

Cowart said this scheme has not affected Louisiana Blue, but continues to be a concern nationwide.

It begins with small signs on utility poles or near intersections with a phone number and a note about diabetic testing supplies. When someone calls, they are encouraged to test their blood sugar less frequently than their doctor recommends and sell back the unused testing strips. Cowart said the victims of this fraud are often on Medicare Advantage plans and are retired with limited incomes.

“This scheme can be hazardous because testing strips that are sold back as part of this scheme are at risk of making their way back into the mainstream supply chain. They haven’t been handled or stored properly, which means they potentially don’t work the way they should. That can lead to other health consequences,” Cowart said. “Meanwhile, the person who called the number on the sign isn’t testing their blood as often as they should, which can be harmful.”

Cowart said advances in technology and artificial intelligence have impacted how fraud occurs. Electronic databases store millions of people’s personal information, and some bad actors have been able to breach them for a wide range of schemes. In addition, Cowart said fraudsters are now better able to call victims with some personal details in hand, which can unfortunately create a sense of trust.

“When someone calls and says they know your birth date, Medicare number or physician’s information, it can make people feel more secure about giving them their Social Security number or banking information,” she said. “People need to be really diligent about not giving out any information unless they know exactly who they are talking to, and never give any information to someone who cold calls you.”

Cowart said a better strategy is to ask for the caller’s name, title, department and company, then end the call and find the company’s main number online.

“If the person is legitimate, you will get routed back to them by calling the known number,” she said. “I encourage people to do this if they receive an unexpected call.”

If someone does fall victim to Medicare fraud, Cowart said it is critical that they report the situation. Reports can be made by calling 1-800-MEDICARE, the number on a Medicare Advantage card, the Louisiana Blue fraud and abuse hotline at 1-800-392-9249, or filing a report with the FBI at ic3.gov.

“Fear and embarrassment are the main reasons victims don’t come forward, even to their families,” Cowart said. “In addition, they can be reluctant to report it to authorities because they think nothing will happen. Medicare or the FBI may not open a major case for one incident, but they record every case and will launch an investigation if they see a large number of similar complaints. They are always looking for patterns. If individual instances are not recorded, those patterns are never seen.”