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Sheaffer: Medicare Fraud

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Let's talk Medicare. We're not getting into the various parts of Medicare, but we are going to take a look at how fraud has continued to hit the Medicare system.

It used to be that when we heard about "organized crime", we pictured everything from 1930's machine gun toting bad guys to Ponzi schemes and illegal gambling. As with the rest of society, crime has kept up with cultural changes and relevant "opportunities".

Some may be surprised that Medicare is a huge target, and a while back, I read that approximately $60 billion has been scammed from Medicare---and that just in one year. Fraud runs rampant and where's there's money to be made, scammers will gather.

The old standbys of a phone call or email from someone representing Medicare in order to get your personal information still occur. If it works, why change? As of right now, most Medicare numbers are also your Social Security number (more news on that later) and that can bring all sorts of grief in the wrong hands.

Identity theft, or charging services or merchandise to your account are only a couple ways that can leave you digging out of a very deep hole. Just as with other unknowns, we need to check things out. If you get a call from "Medicare" and they want your number, think: Doesn't Medicare already have that? Or maybe they just want to "confirm" your number.

Hang-up, delete the email hold on to the letter or whatever, and call Medicare to confirm if it's legitimate. ("Delete" is one of my favorite buttons on email.)

Another place to check is your Medicare Summary Notice you receive in the mail. It really helps to read it. There may be honest errors resulting in charges made to your account; or there may bogus claims for equipment and services you never received. The aforementioned bad guys sometimes set-up phony medical supply offices and once they have some Medicare numbers bill Medicare without doing anything but shuffling papers.

Shouldn't somebody be doing something about this?

Indeed! And things are being done. Earlier we mentioned the Medicare numbers being Social Security numbers--this is the "more news on that later" piece. Beginning this April, the Centers for Medicare & Medicaid Services (CMS) will start mailing out new cards with numbers called Medicare Beneficiary Identifiers. Simply put, these are numbers that have no correlation to your SS number.

It'll take about 12 months to get the cards out to everyone, and in the meantime, you can go to www.insurance.wa.gov/new-medicare-cards-are-coming on the Office of Insurance Commissioner website. It shows what the new numbers look like, how they differ and so on.

And by the way, this might be another window scammers try to sneak through. Be wary of anyone who contacts you about your new card, new number, personal information, etc. It won't be Medicare.

That's one way fraud is being dealt with. Another is through reporting. If you know about a Medicare fraud incident, or suspect it, you can report it through the Medicare website (www.medicare.gov) or the Office of the Insurance Commissioner (www.insurance.wa.gov).

Or, you can call either of the numbers at the end of the column and ask to talk to a SHIBA (Statewide Health Insurance Benefits Advisors) staff member.

Somebody is doing something about Medicare fraud--we are. All of us together.

Information & Assistance

Long Beach: 642 3634/888 571 6558

Raymond: 942 2177/888 571 6557

www.o3a.org

sheafdf@dshs.wa.gov

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