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Medicare Fraud Prevention Week Teaches Everyone How to Prevent Fraud

By the Senior Medicare Patrol Resource Center

Medicare Fraud Prevention Week focuses on the actions everyone can take to prevent Medicare fraud, errors, and abuse. June 2022 marks the 25th anniversary of the Senior Medicare Patrol (SMP) program. To commemorate this event, the SMP is creating a national week focused on Medicare fraud prevention.

Medicare loses an estimated $60 billion each year due to fraud, errors, and abuse. Every day, issues related to these concerning matters affect people across the country, often costing them money, time, and well-being. Medicare-related errors contribute to this annual loss even though errors can be honest health care billing mistakes. However, a pattern of errors committed by a physician or provider could be considered a red flag of potential fraud or abuse if not corrected.

When people steal from Medicare, it hurts us all and is big business for criminals. Some common examples of fraud or abuse could include:

  • Charging for services or supplies that were not provided
  • Misrepresenting a diagnosis, a person’s identity, the service provided, or other facts to justify payment
  • Prescribing or providing excessive or unnecessary tests and services

The most effective way to stop fraud from occurring is to prevent it in the first place. Educating yourself and your loved ones on how to prevent Medicare fraud, errors, and abuse is the best place to start.

Everyone plays a part in the fight against fraud. During Medicare Fraud Prevention Week:

  • Medicare beneficiaries can monitor their insurance statements to make sure products and services received match what is on the statements. They can request free My Health Care Trackers from their local SMP.
  • Caregivers can help by being on the lookout for items such as durable medical equipment (like boxes of knee braces) lying around the house that may have been shipped to the beneficiary without their or their doctor’s approval. They can remind their client or loved one to never give out their Medicare number or other personal information over the phone.
  • Families can help by talking to their loved ones about protecting their Medicare number just as they would a credit card number. They can help their loved ones create a account to access their Medicare statements online or remind them to open and review them when they come in the mail. They can also register their phone number on “do not call” lists and go to to opt out of mailings.
  • Partners and professionals can help by sharing SMP information on social media, referring clients and consumers to the SMP, and inviting the SMP to speak during a shared event.
  • Health care providers can help by talking to patients about health care-related scams such as those related to durable medical equipment and genetic testing schemes. They can remind them that products and services should only be ordered by physicians they regularly see. Needed medical items should never be ordered through TV ads or unsolicited calls.
  • Community members can help by looking out for older neighbors. When in public, they can be aware of older individuals purchasing gift cards in large amounts. They can encourage those they know to talk to a trusted source about their Medicare questions and tell neighbors about the most recent Medicare scams. They can even consider volunteering with the local SMP!

SMP is a national program that educates Medicare beneficiaries about Medicare fraud, errors, and abuse. Learn how you can protect yourself and your loved ones from Medicare fraud by joining us on 6/5 to kick off this week of celebration and education! Visit our website for more information on Medicare Fraud Prevention Week.

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Get the flu shot this fall

Originally posted September 17, 2020 on

The Centers for Disease Control and Prevention (CDC) recommends everyone 6 months and older get a yearly flu shot by the end of October. By getting the shot, you’re helping to lower the spread of flu-related illnesses, hospitalizations, and even death.


3 more reasons it’s important to get your flu shot:

  • With Marketplace health insurance, your flu shot is free from a provider in your plan’s network. Immunization vaccines are a covered preventive care benefit.
  • While babies, children, and older people are most vulnerable, no one is immune from the flu.
  • Getting vaccinated is more important than ever. Getting the shot helps reduce illness and preserve health care resources as the country battles the coronavirus disease 2019 (COVID-19) emergency.

According to the CDC, the flu vaccine doesn’t increase the risk of getting COVID-19. When you get your shot, try your best to maintain social distancing, avoid waiting areas, and always wear a mask.

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By Charles Clarkson, Project Director Senior Medicare Patrol of New Jersey


Medicare and other scams affecting seniors have become a major problem. According to the National Council on Aging, scams against seniors have become “the crime of the 21st century.” Seniors are a targeted population. A senior might be targeted because of dementia, frailty, or loneliness. Seniors might also have assets that can be considered easy pickings by fraudsters.

    1. Medicare and health insurance scams. Almost every senior citizen becomes eligible for Medicare when he or she turns 65. At the Senior Medicare Patrol of New Jersey (SMPNJ), we run into these scams all the time:
        • Callers who represent themselves as being from Medicare and ask for personal information. Medicare does not call Medicare beneficiaries to ask for personal information. At the SMPNJ we have heard that one of the new scams is beneficiaries being told that Medicare is issuing new chip embedded Medicare cards and they need to confirm their Medicare
        • Callers who offer free braces to unwitting seniors. These braces are delivered to beneficiaries who have not seen a doctor and are not medically
        • Genetic testing scams at health fairs are offered free to assist your doctor in treating you better or as a preventive service. These tests go by many names, including cancer screening, DNA screening, hereditary cancer screening, dementia screening, and pharmacogenomics – medication metabolization. Medicare beneficiaries should not voluntarily participate in any of these tests unless they are ordered by adoctor who knows their history and believes the test to be medically necessary to properly treat them.
    2. Counterfeit prescription drugs. The high cost of prescription drugs has led many seniors to seek lower cost drugs. The danger to seniors is not knowing where the drug came from or was manufactured, the ingredients in the drug, which can be harmful, and even whether the drug is made to treat your symptoms. Don’t buy drugs over the internet. Go to your local pharmacy to purchase all your drugs, and if you have any questions, consult your
    3. Telemarketing scams. Telemarketing has become an easy way for fraudsters to scams seniors. Many seniors will always pick up the phone and have been doing so all of their lives. Many seniors are also familiar with and comfortable ordering things on the phone. We at the SMPNJ have this warning: IF YOU RECEIVE A CALL AND YOU DO NOT RECOGNIZE THE CALLER’S TELEPHONE NUMBER, DO NOT PICK UP THE CALL. LET THE ANSWERING MACHINE SCREEN ALL OF YOUR

What most seniors will find is that no message is left — an indication that the call is a scam or an unsolicited invitation to buy something.

    1. Other Common Scams. While the SMPNJ mostly deals with Medicare and other health-related scams, we do see other scams that affect Medicare beneficiaries:
        • Grandparent Scam. This scam where a grandparent is called by someone saying a grandchild is hurt or in jail and the grandparent is asked to send money. The scam seeks to rely on the love of a grandparent for a grandchild, making the grandparent act without asking the right questions or seeking to establish whether the call is genuine. The caller, having done some background research, might know the names of the grandparent and the grandchild in
        • Social Security Scam. This scam seems to be on the rise, and the SMPNJ is hearing from many Medicare beneficiaries that they have received calls reportedly from the Social Security Administration indicating that their Social Security numbers have been involved in some criminal activity and they need to confirm their numbers to assist in resolving this
        • Internal Revenue Scams. As in other IRS impersonation scams, thieves make unsolicited phone calls to their intended victims fraudulently claiming to be from the IRS. In the most recent scam variation, callers “spoof” the telephone number of the IRS Taxpayer Advocate Service (TAS) office in Houston or Brooklyn. Calls may be “robo-calls” that request a call back. Once the taxpayer returns the call, the con artist requests personal information, including a Social Security number or individual taxpayer identification number. Like most agencies, IRS and TAS do not initiate calls to taxpayers “out of the blue.” Typically, a taxpayer would contact TAS for help first, and only then would TAS reach out to the taxpayer. In other variations of the IRS impersonation phone scam, fraudsters demand immediate payment of taxes by a prepaid debit card or wire transfer. The callers are often hostile and abusive. Alternatively, scammers may tell would-be victims that they are entitled to a large refund, but must first provide personal information.

Scams and scam artists will always be an issue. Beneficiaries must now be more vigilant than ever before to protect themselves from Medicare and other scams. If you need help with a Medicare scam, call the SMPNJ at 1-732-777-1940 or at our hotline number 1-877-SMP-4359 (1-877-767-4359). Please also visit our website at If you need more information about Medicare scams or wish to inform us of a Medicare scam online, click on Report Fraud.


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Fraud Alert: Genetic Testing Scam

The U.S. Department of Health and Human Services Office of Inspector General is alerting the public about a fraud scheme involving genetic testing.

Scammers are offering Medicare beneficiaries cheek swabs for genetic testing to obtain their Medicare information for identity theft or fraudulent billing purposes. Fraudsters are targeting beneficiaries through telemarketing calls, booths at public events, health fairs, and door-to-door visits.

If a beneficiary agrees to genetic testing or verifies personal or Medicare information, a testing kit is sent even if it is not ordered by a physician or medically necessary.

Protect Yourself

  • If a genetic testing kit is mailed to you, don’t accept it unless it was ordered by your physician. Refuse the delivery or return it to the sender. Keep a record of the sender’s name and the date you returned the items.
  • Be suspicious of anyone who offers you free genetic testing and then requests your Medicare number. If your personal information is compromised, it may be used in other fraud schemes.
  • A physician that you know and trust should approve any requests for genetic testing.
  • Medicare beneficiaries should be cautious of unsolicited requests for their Medicare numbers. If anyone other than your physician’s office requests your Medicare information, do not provide it.
  • If you suspect Medicare fraud, contact the HHS OIG Hotline.

Last updated: June 3, 2019

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New App Displays What Original Medicare Covers

Today, the Centers for Medicare & Medicaid Services (CMS) launched a new app that gives consumers a modernized Medicare experience with direct access on a mobile device to some of the most-used content on

The new “What’s Covered” app lets people with Original Medicare, caregivers and others quickly see whether Medicare covers a specific medical item or service. Consumers can now use their mobile device to more easily get accurate, consistent Original Medicare coverage information in the doctor’s office, the hospital, or anywhere else they use their mobile device. In addition to the “What’s Covered” app, through Blue Button 2.0 the agency is enabling beneficiaries to connect their claims data to applications and tools developed by innovative private-sector companies to help them understand, use, and share their health data.

“eMedicare is one of several initiatives focused on modernizing Medicare and empowering patients with information they need to get the best value from their Medicare coverage,” said CMS Administrator Seema Verma. “President Trump is delivering on his commitment to Medicare by modernizing tools that deliver health information in the most convenient way possible. This new app is the next in a suite of products designed to give consumers more access and control over their Medicare information.”

CMS created the app to meet the needs of the growing population of people with Medicare. The Medicare population is projected to increase almost 50 percent by 2030—from 54 million beneficiaries in 2015 to more than 80 million beneficiaries in 2030. As of 2016, about two-thirds of Medicare beneficiaries indicate they use the Internet daily or almost daily (65 percent). Questions about what Medicare covers are some of the most frequent inquiries that CMS receives. There are approximately 15 million page views annually for coverage-related content on and 1-800 MEDICARE receives over 3 million coverage-related calls each year.

CMS launched the eMedicare initiative in 2018 to empower beneficiaries with cost and quality information. Other tools in the eMedicare suite include:

  • Enhanced interactive online decision support to help people better understand and evaluate their Medicare coverage options and costs between Medicare and Medicare Advantage.
  • A new online service that lets people quickly see how different coverage choices will affect their estimated out-of-pocket costs.
  • New price transparency tools that let consumers compare the national average costs of certain procedures between settings, so people can see what they’ll pay for procedures done in a hospital outpatient department versus an ambulatory surgical center.
  • A new webchat option in the Medicare Plan Finder.
  • New easy-to-use surveys across so consumers can continue to tell us what they want.

The eMedicare initiative expands and improves on current consumer service options. People with Medicare will continue to have access to paper copies of the Medicare & You handbook and Medicare Summary Notices.

The What’s Covered app is available for free in both Google Play and the Apple App Store. The app is available in Google Play at:, and is available in the Apple App Store at:


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Federal Trade Commission Scam Warning

The Federal Trade Commission is getting reports about people pretending to be from the Social Security Administration (SSA) who are trying to get your Social Security number and even your money.

In one version of the scam, the caller says your Social Security number has been linked to a crime (often, he says it happened in Texas) involving drugs or sending money out of the country illegally. He then says your Social Security number is blocked – but he might ask you for a fee to reactivate it, or to get a new number. He will ask you to confirm your Social Security number.

In other variations, he says that somebody used your Social Security number to apply for credit cards, and you could lose your benefits. He also might warn you that your bank account is about to be seized, that you need to withdraw your money, and that he’ll tell you how to keep it safe.

All of these are scams. Here’s what you need to know:

  • The SSA will never call and ask for your Social Security number. It will not ask you to pay anything. It won’t call to threaten your benefits.
  • Your caller ID might show the SSA’s real phone number (1-800-772-1213), but that’s not the real SSA calling. Computers make it easy to show any number on caller ID. You cannot trust what you see there.
  • Never give your Social Security number to anyone who contacts you in this way. Do not confirm the last 4 digits. Do not give a bank account or credit card number – ever – to anybody who contacts you by phone asking for it.
  • Remember that anyone who tells you to wire money, pay with a gift card, or send cash is always a scammer no matter who they say they are.

If you’re worried about a call from someone who claims to be from the Social Security Administration, get off the phone. Then call the real SSA at 1-800-772-1213.

If you have spotted a scam, then tell the FTC at

To learn more, you can go to Fake Calls about your SSN.


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Charles Clarkson’s guest appearance on Aging Insights

The newest episode of Aging Insights is titled, Medicare Cards and More (Episode 83). On this program, Melissa Chalker speaks with Mary McGeary, Director of the SHIP Program at NJ Div. of Aging Services and Charles Clarkson, Project Director of Senior Medicare Patrol of NJ. Our guests remind us about all of the ins and outs of Medicare coverage, how to look out for Medicare fraud and of course, everything you need to know about your new Medicare card.

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The Cost of Medicare Fraud

Medicare fraud, waste and abuse costs taxpayers an estimated $60 billion a year.  When Medicare dollars are used to pay fraudsters, all taxpayers suffer.  These are dollars that are not being used to pay for legitimate claims for Medicare services.  For this reason, the Senior Medicare Patrol program was established to assist Medicare beneficiaries to fight fraud, waste and abuse.  Let the Senior Medicare Patrol of New Jersey help you.  If you cannot resolve issues of fraud, waste or abuse on your own, we can assist you.  The Senior Medicare Patrol of New Jersey has many trained volunteers who will investigate the facts of your complaint and help you to resolve it.

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Medicare Fraud, Waste and Abuse

When Medicare providers intentionally submit claims to Medicare for services not provided, unnecessary medical services or they double bill or up-code (bill for a higher value service than the one provided), they are committing Medicare fraud.  These are but a few of the examples of Medicare fraud.  You as a Medicare beneficiary and a taxpayer can help prevent this fraud, waste and abuse by contacting the Senior Medicare Patrol of New Jersey at  732-777-1940 or our toll free hotline  at 877-SMP-4359 (877-676-4359.)  Remember, providers who are committing Medicare fraud are stealing from you, the American taxpayer.  Let’s join together and continue the fight against Medicare fraud, waste and abuse.

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Do You Worry About Your Elderly Parents?

Do You Worry About Your Elderly Parents?

SMP and Jewish Family Services do also. The following tips will help you protect your loved ones from being a victim of a Medicare scam.
TIP 1: DO NOT give out your Medicare # to anyone you do not trust. Safeguard your number as you would your bank account or credit card numbers.
TIP 2: Hang up the phone or shut the door if you are contacted by someone claiming to be a Medicare representative. Guess what… Medicare will not call you or make a home visit. “It’s shrewd to be rude.”
TIP 3: Shred your Medicare, health care, and other important documents before throwing them away. Take advantage of free community shredding events.
TIP 4: Be sure to read your Medicare Summary Notice even though it says “This is Not a Bill.” Be on the lookout for services which were not provided, services that were billed twice, or for services not ordered by your doctor. If you see something that doesn’t look right, call your doctor’s billing office right away.
TIP 5: Use a calendar or health care journal to record all of your doctor visits, medical tests and procedures. Compare your Medicare Summary Notice with your calendar or journal. If you see something that does not look right, call your doctor’s billing office right away.