Posing as nurses, certain individuals go door to door looking for senior citizens who may want help. Those who answer affirmatively are then asked for their Medicare or Medicaid number and billed for services — regardless of whether the service is ever provided.
Similarly, unscrupulous doctors or pharmacists look to fatten their insurance reimbursement by scamming seniors who, they believe, will never look closely at their bills or their medication.
This practice seems to run rampant throughout much of the country, as well as in New Jersey, costing U.S. taxpayers an extra $60 billion annually in fraud, waste and abuse, according to a press release. It puts an added strain on governmental insurance programs that are already under increased scrutiny by budget-conscious legislators.
“Many of these scams take advantage of seniors who unwittingly give out their Medicare number to unscrupulous people saying they represent Medicare,” said Charles Clarkson, who is the statewide coordinator for the SMP of New Jersey. “Our goal is to educate seniors so they can spot a scam before it happens and report it to our hot line number.” To educate seniors so they can identify common scams and report them, SMP of New Jersey will be giving a presentation on Sept. 23 at 10 a.m. at the Monmouth County Library Headquarters, Symmes Drive, Manalapan.
Under the auspices of Jewish Family and Vocational Service of Middlesex County (JFVS), the SMP of New Jersey is part of a national program that consists of 54 community-based projects located in every state, as well as in the District of Columbia, Guam, Puerto Rico and the U.S. Virgin Islands, according to the press release.
Since originating in 1997, the national program has reached more than 18 million people and documented more than $105.9 million in savings.
In 2010, Clarkson’s group, which includes 20 or so active volunteers, gave more than 130 presentations to senior audiences at community centers, libraries, clubs, churches and synagogues throughout the state.
“Everyone has a stake in this because the money lost to these practices has an impact on premiums and deductibles and, particularly in difficult financial times like these, could result in cutbacks that would leave certain services uncovered,” said Clarkson. “It is a fraud that can be largely stopped dead in its tracks if people know the facts.”
Clarkson said SMP of New Jersey hopes to make consumers more aware of the problem by offering these tips:
Remember that only personal physicians, hospitals or clinics are permitted to make referrals for special equipment, services or medication.
Treat your Medicare card like your Social Security number – never give it out to callers or visitors saying they represent Medicare. They do not make uninvited trips or calls.
Medicare drug prescription plans cannot enroll you into a drug plan over the telephone unless you call them.
Never show anyone your medical or prescription records without first talking to your doctor or pharmacist.
Shred your Medicare or other health care papers before throwing them away. Crooks will go through the trash.
If someone offers to buy your Medicare or Medicaid number, do not do it.
Remember that Medicare does not sell or endorse anything.
If you suspect an error or fraud related to health care, gather the facts and report it to the SMP hotline number.
Always read your Medicare Summary Notice, which is stamped “This is Not a Bill” and arrives after you receive Medicare services. Look for three things in particular: charges for something you did not receive, billing for the same thing twice, and services that were not ordered by your doctor.
“Fraud is causing costs to go through the roof,” said Clarkson. “It all begins and ends with the consumer, which is why education is so important.”
To report a possible fraud in New Jersey, consumers can call the SMP of New Jersey toll-free hotline number, 877-SMP- 4359, or Jewish Family and Vocational Service at 732-777-1940.