Seniors Should Review Their Medicare Summary Statements

"Most people only look to see if there is a zero balance and don't look at the other parts of the statement," Wyatt explained.
Seniors Should Review Their Medicare Summary Statements

Wanda Wyatt, 74, felt violated when she discovered that her Medicare information had been stolen and used to obtain $500 worth of COVID-19 testing.

"I felt like someone had broken into my house and looked at my personal medical information and other things," she explained.

On Friday, Wyatt sat at her kitchen table and showed a guest where to check on the Medicare monthly summary form.

"Most people only look to see if there is a zero balance and don't look at the other parts of the statement," Wyatt explained.

One issue she ran through could have cost her a benefit. If she had required a COVID test, she would have been refused since the thief charged Medicare $500 for COVID tests, which was Wyatt's limit. Furthermore, if the fraudster had been successful in gaining government funding for further medical operations, tests, or equipment in Wyatt's name, she would have been denied those services as well.

Fortunately, Wyatt has not required a COVID test, and she hopes she has prevented the burglar from stealing from her again. She called Medicare and followed the steps to receive a new Medicare number and card. She must now update her Medicare number at her doctor's office and everywhere else she has used it.

Wyatt expressed amazement that her phone number had been stolen because she is meticulous.

"I've never given out my phone number to anyone over the phone, and whenever I visit a doctor's office, I make sure I get my card back."

Widespread Fraud

Wyatt's theft is not surprising on a national scale. Every year, billions of money are squandered on criminals. According to the National Health Care Anti-Fraud Association, between three and ten percent of the billions of dollars spent on Medicare payments each year are false. In Wyatt's case, she also called a Birmingham television station, where an investigative reporter checked, called her back, and informed her that the names and addresses of the businesses making claims were false.

"One location was in a vacant field," she explained, "while the others were in abandoned buildings." Some had fraudulent websites."

The methods used by those who steal Medicare numbers or cheat the program vary. An individual's Medicare number is often stolen by a health care facility employee and sold to organized criminal units or gang leaders. Some phone or visit senior adults and offer them the chance to take "free services" that are not free, after which they ask for their Medicare number. Others call and offer to pay an elderly citizen a fee in exchange for disclosing their phone number.

There are numerous sorts of fraud. Some medical establishments reimbursed their patients. Others overcharge for services that are never provided, or they perform unneeded tests and procedures.

Ron Elfenbein, a doctor in Baltimore, Maryland, defrauded the federal government of $15 million by ordering more tests when patients had not requested or needed tests beyond the basic COVID-19 exams, and he instructed his subordinates on why he wanted them to schedule the additional tests.

Fraud is not without victims in various ways. According to an examiner with the Department of Health and Human Services, employers and individuals pay higher premiums as a result of fraud, and taxpayers lose approximately $100 billion each year.

The Center for Health Progress, based in Denver, Colorado, recommends that Medicare participants take the following three steps to avoid fraud:

• Before employing a new physician, confirm that he or she has no history of engaging in fraudulent practices.

• Examine pre-payment and post-payment claims to ensure that no needless operations are planned or reported.

• If you are a victim of fraud, notify it to help prevent future theft.

"Those in the fraud department were very helpful," Wyatt explained.

She's also doing her part to spread the news, telling family and friends about it on social media and in person.

To report a case of fraud, dial 1-800-633-4227. The phone line is available 24 hours a day, seven days a week.