Archived Story

Medicare fraud: Curbing a billion-dollar problem

Published 2:47pm Friday, January 11, 2013

Every year, Medicare pays out approximately $500-600 billion in claims.

Cyndi Caine, senior Medicare Patrol Program coordinator, said an estimated $60-90 billion of those claims are fraudulent. Caine works to prevent Medicare fraud through educating seniors on how to protect their personal information.

Like most scams, it starts by an individual phishing for information. Caine said individuals posing as Medicare employees are calling seniors, asking for their Medicare information so they can send them a new card.

This should be the first red flag, Caine said.

“Medicare is not allowed to contact you at home,” Caine said. “If you ever get a call from someone saying they are from Medicare, that is a scam right off the bat.”

The callers are asking seniors to confirm details such as their name, address and Medicare number, Caine said. While seniors should safeguard all their personal information, Caine said seniors should take extra care to protect their Medicare number.

“I have been shocked by the number of people that don’t know their Medicare number is their Social Security number,” Caine said.

That Medicare number will then be sold and used to make fraudulent claims or to open credit cards or bank accounts.

“The majority of these scams are being done by doctors, hospitals, nursing homes or medical equipment companies,” Caine said. “They are charging for tests they aren’t giving, for appointments that never happened and equipment – that really depressed me because those are the very folks that should be protecting the elderly.”

Caine said more than 7,000 people in Tallapoosa County are currently on Medicare.

Of these seniors, Caine said that most are not taking advantage of their best tool to fight fraud – the Medicare summary notice.

“Every 90 days, Medicare sends a statement out to anyone over 65 – it lists everything that has been charged to Medicare,” Caine said. “Ninety-nine percent of the people I talk to tell me they don’t look at them.”

While the Medicare statement is not a bill, Caine said it is important to look at.

“This is how you find out if there are charges on there for services you didn’t actually get,” Caine said.

All too many seniors find out about unauthorized claims the hard way, Caine said.

“I had a client who told me she needed an electric wheelchair, but Medicare had told her she already had one,” Caine said. “Now she needs one, but Medicare won’t pay for another. This is part of why it is extremely important to ready summary notices.”

Caine said that seniors can call her office if they suspect they are a victim of Medicare fraud. Also, Caine said they can arrange presentations on fraud for interested groups.

“Ten thousand people a day turn 65 and go on Medicare, and that will continue for the next 18 years until all baby boomers turn 65,” Caine said. “That is 10,000 more potential victims each day.”

Caine also added that her program is also seeking volunteers 50 and over to assist in giving presentations.

To find out more about Medicare fraud or how to become a volunteer, call 1-800-243-5463. You can also find out more information by visiting