MEDICARE FRAUD ALERT-ROBOCALLS

Robocall scams can often seem random, but that’s not always the case. Sometimes they are highly targeted — as with older Americans whose Medicare eligibility opens the door to health insurance fraud.

Be aware that bad actors may spoof the number that appears on your caller ID so that an incoming call seems to be from a government agency or a health provider that you already know and trust. They do this to entice you to answer.

When you pick up, a scam caller usually starts chatting you up to engage you, asking you conversational questions to put you at ease. Whatever scam scenario follows, the caller is trying to get your personal information, such as your Medicare card number, your Social Security number, or other health insurance identification.

For your awareness

  • Medicare does not call you uninvited and ask you for personal or private information.
  • You will usually get a written statement in the mail before you get a phone call from a government agency.
  • Calls requesting health insurance information should not be trusted.

Medicare.gov advises that you take the following precautions:

  • Never give your Medicare card, Medicare number, Social Security card, or Social Security number to anyone except your doctor or people you know should have it (like insurers acting on your behalf or people who work with Medicare, like your State Health Insurance Assistance Program (SHIP). Get the contact information for your local SHIP.).
  • Do NOT accept offers of money or gifts for free medical care.
  • Do NOT allow anyone, except your doctor or other Medicare providers, to review your medical records or recommend services.
  • Never Join a Medicare health or drug plan over the phone unless YOU called Medicare.
  • If someone asks you for your information or for money, or threatens to cancel your health benefits if you don’t share your personal details, hang up and call 1-800-MEDICARE (1-800-633-4227) or visit medicare.gov.

Be vigilant. Scammers can be very convincing, and they may know a little — or a lot — about you, especially if they have access to some of your personal information already. Follow these simple tips to avoid spoofing scams:

  • Do NOT  answer calls from unknown numbers.
  • If you answer and the caller is not who you expected, hang up immediately.
  • Never give out personal information such as account numbers, Social Security numbers, mother’s maiden names, passwords, or any other self-identifying response to an unexpected call.
  • Use caution if you are being pressed for information immediately.
  • If a caller claims to represent a health insurance provider or a government agency, simply hang up. You can then call back using a phone number on an account statement, in the phone book, or on an official website to verify the caller’s authenticity.

Lab and University Resolve Allegations

Laboratory Corporation of America Holdings, Laboratory Corporation of America, Labcorp Tennessee LLC, and University Health System Inc. have paid more than $388,000 to resolve allegations that they violated the False Claims Act by delaying the submission of physician orders for certain laboratory tests by Caris Life Sciences Inc. to enable improper billings to Medicare for those tests. According to filed documents, physician orders for testing were delayed – by either holding orders for submission or canceling and resubmitting orders – until 14 days after a Medicare beneficiary’s discharge from the hospital to circumvent Medicare’s Date of Service Rule. Listen to and read a story from WBIR and read a Department of Justice press release.

 

SMP Resource Center products often contain links to copyrighted material. The SMP Resource Center is providing these links as a convenience and for informational purposes in our efforts to report and educate on Medicare fraud; they do not constitute a guarantee, endorsement, or approval by SMP of any of the information available on the external site. SMP bears no responsibility for the accuracy, legality, or content of the external site or for that of subsequent links. If you have any questions or concerns about the links provided, please contact the SMP Center at nliebau@smpresource.org. 

Telehealth Company Agrees to Pay

CompreCare Health LLC and its affiliates, doing business as Meditelecare LLC, agreed to pay more than $358,000 to resolve allegations of overbilling Medicare. The United States alleged that Meditelecare submitted and caused the submission of claims to Medicare for telehealth psychotherapy sessions that did not meet the minimum time requirements for payments and relied on false time records in support of these same telehealth services. Read a story from the Inside Investigator and a Department of Justice press release.
SMP Resource Center products often contain links to copyrighted material. The SMP Resource Center is providing these links as a convenience and for informational purposes in our efforts to report and educate on Medicare fraud; they do not constitute a guarantee, endorsement, or approval by SMP of any of the information available on the external site. SMP bears no responsibility for the accuracy, legality, or content of the external site or for that of subsequent links. If you have any questions or concerns about the links provided, please contact the SMP Center at nliebau@smpresource.org. 

Update: Owner of Addiction Treatment Chain Sentenced

In an update to an August 1, 2024, story, Michael Brier has been sentenced to more than eight years in federal prison and ordered to pay more than $3.5 million in restitution. Read a Department of Justice press release.

Michael Brier and Recovery Connections Centers of America Inc. (RCCA) admitted that they failed to provide patients with required counseling sessions and treatment while simultaneously billing Medicare, Medicaid, and other health care payors routinely for 45-minute counseling sessions even though the sessions were often only five to 10 minutes or less. Briar and RCCA also admitted that they caused a fraudulent application to be submitted to Medicare that, among other things, misrepresented and concealed the role that Brier was playing in the business and failed to disclose Brier’s 2013 criminal conviction for federal tax crimes. Read a story from ABC6 and a Department of Justice press release.

 

SMP Resource Center products often contain links to copyrighted material. The SMP Resource Center is providing these links as a convenience and for informational purposes in our efforts to report and educate on Medicare fraud; they do not constitute a guarantee, endorsement, or approval by SMP of any of the information available on the external site. SMP bears no responsibility for the accuracy, legality, or content of the external site or for that of subsequent links. If you have any questions or concerns about the links provided, please contact the SMP Center at nliebau@smpresource.org. 

Woman Receives Scam Calls

After 88-year-old Ruth Ferguson’s doctor told her she needed a medical device to alleviate leg pain, scam calls started. Ferguson said a woman who impersonated a CVS pharmacy wanted to sell her a leg brace. Another caller claiming to represent Medicare said he could provide a cancer-detecting device. Watch and read a story from FOX 13.

SMP Resource Center products often contain links to copyrighted material. The SMP Resource Center is providing these links as a convenience and for informational purposes in our efforts to report and educate on Medicare fraud; they do not constitute a guarantee, endorsement, or approval by SMP of any of the information available on the external site. SMP bears no responsibility for the accuracy, legality, or content of the external site or for that of subsequent links. If you have any questions or concerns about the links provided, please contact the SMP Center at nliebau@smpresource.org.

Pharmacist Accused of Fraud, Identity Theft

Philip Hall has been charged with nine counts of health care fraud and six counts of aggravated identity theft. He was a licensed pharmacist and the owner, operator, and registered agent of Hall Family Pharmacy Inc. Prosecutors say he submitted false claims for prescriptions for drugs that were medically unnecessary, not actually dispensed, or were not ordered by a physician or other health care provider. He allegedly used the identification of other people without their authorization to obtain reimbursement for claims. See a story from WVLT and read a Department of Justic press release.

 

SMP Resource Center products often contain links to copyrighted material. The SMP Resource Center is providing these links as a convenience and for informational purposes in our efforts to report and educate on Medicare fraud; they do not constitute a guarantee, endorsement, or approval by SMP of any of the information available on the external site. SMP bears no responsibility for the accuracy, legality, or content of the external site or for that of subsequent links. If you have any questions or concerns about the links provided, please contact the SMP Center at nliebau@smpresource.org.

Scam Alert: Scammers are billing for unneeded urinary catheters

WASHINGTON, Feb. 27, 2024 /PRNewswire/ — Medicare beneficiaries across the country are finding charges worth thousands of dollars on their Medicare statements related to urinary catheters that were not needed or received.

“Scammers are taking advantage of the Medicare program and billing for unnecessary products, which is hurting the program. This is also putting Medicare beneficiaries’ Medicare card numbers at risk and compromising their medical identities,” said Nicole Liebau, director of the Senior Medicare Patrol (SMP) Resource Center. The SMP program, which exists in every U.S. state, Puerto Rico, Guam, the U.S. Virgin Islands, and Washington, D.C., empowers and assists Medicare beneficiaries, their families, and caregivers to prevent, detect, and report health care fraud, errors, and abuse.

SMPs started receiving complaints of urinary catheter claims in May 2023. They saw a handful of complaints per month until August 2023, when the number of complaints jumped 750%. Through the end of the year, SMPs continued to receive a staggering number of complaints, with the highest amount received in December 2023 to date.

The SMP program recommends that people regularly check their and/or their loved ones’ Medicare statements to make sure that Medicare wasn’t billed for items or services that were never requested or received. To learn how to readMedicare statements or get help with a compromised Medicare number, contact your local SMP. They can help you request a new Medicare number and report the claims.

The Senior Medicare Patrol (SMP) is ready to provide you with the information you need to PROTECT yourself from Medicare fraud, errors, and abuse; DETECT potential fraud, errors, and abuse; and REPORT your concerns. SMPs help educate and empower Medicare beneficiaries in the fight against health care fraud. Your SMP can help you with your questions, concerns, or complaints about potential fraud and abuse issues. It also provides information and educational presentations. To locate your local Senior Medicare Patrol, call toll-free 877-808-2468 or visit www.smpresource.org.

Contact Information
Senior Medicare Patrol Resource Center
Nicole Liebau
1-877-808-2468
info@smpresource.org

SOURCE SMP Resource Center