Medicare Open Enrollment Attracts Enrollees and Scammers Alike

The Federal Trade Commission has released a consumer alert warning consumers about common ways scammers try to get money during enrollment season, which started on October 15 and lasts until December 7.

Medicare fraud costs Americans an estimated $60 billion every year, according to the Social Security Administration. Organizations have formed to combat this and raise awareness.

The CMS Fraud Prevention Initiative screens providers and predictive modeling technology to detect scams. In 2018, CMS released new Medicare cards without Social Security numbers on them.

The Department of Health and Human Services Office of the Inspector General Medicare Fraud Strike Force was developed in 2007 and currently works with law enforcement in 16 cities to identify and prosecute fraud.

The Senior Medicare Patrol (SMP) which receives grants from the Administration for Community Living (ACL) to train community members who educate enrollees, is another example. In 2023, SMP projects reported $111,277,683 in expected Medicare recoveries, most of which came from a single case that identified a nurse who had billed enrollees for needless generic tests, medical equipment and telehealth visits that did not occur.

The Medicare population is a popular target for scammers because it provides them access to more than 66 million people in the United States, 89.4% of whom are over 65, according to the CMS.

Scammers use an enrollee’s Medicare or Social Security number to commit identity theft. With this information, criminals can submit fake claims in the beneficiary’s name to get free prescription drugs, healthcare services or supplies, which maxes out benefits and charges enrollees for services they didn’t receive.

Thieves often use the phone to find victims, but they may also email, text or message on social media. They use fear and confusion to their advantage and may also ask members for their credit card information to purchase a new Medicare card, the same card that Medicare replaces for free if lost or stolen. They also may say that the beneficiary is preapproved for a new plan or even share some basic personal details about them for to gain trust, but these are details that can be found with a quick internet search. Some scammers may also say that it's required to return an old Medicare card, which is false. The old card can be destroyed when a new one is received.

Organizations have formed to raise awareness of Medicare fraud, including the Senior Medicare Patrol, which receives grants from the Administration for Community Living (ACL) to train community members who educate enrollees.

Suspicious activity can be reported by calling 1-800-633-4227 or through your local SMP. A list of local patrols can be found on their website or by calling 1-877-808-2468.