Medicare scams with tests for covid can generate other frauds

Medicare coverage for home tests for Covid-19 ended a few days ago, but the scams generated by this temporary benefit could have lasting consequences for seniors.

Medicare advocates who track fraud have seen an increase in complaints among beneficiaries who received tests they never requested.

A sign that someone may be (and may continue to use) Medicare information to illegally bill the federal government.

The Department of Health and Human Services’ Office of Inspector General (OIG) has received complaints from across the country about tests billed to Medicare that were never ordered, an investigator said.

Earlier this year, the OIG published a fraud warning on your websiteurging consumers to report any covid-related scams.

“Unfortunately, most of these scams are the result of stolen Medicare beneficiary information,” Scott Lampert, assistant inspector general for investigations, told KFF Health News.

Being scammed once makes that person more vulnerable in the future.

A stolen Medicare number can be used repeatedly to get payments for all sorts of things, or sold to other scammers, said María Álvarez, who oversees the New York State Senior Medicare Patrol, part of a national program that helps identify and educate beneficiaries about Medicare fraud.

“If you have someone’s Medicare number, you can bill Medicare for medical procedures, tests, drugs, services and equipment,” Álvarez explained. “On the dark web, Medicare numbers are more valuable than credit card or Social Security numbers.”

An Indiana beneficiary suspected something was wrong when he received 32 unsolicited test results in a 10-day period, said Nancy Moore, director of the state’s Senior Medicare Patrol program.

None of the people who filed a complaint recalled giving out their Medicare number, Moore added.

In Ohio, Medicare paid for tests that beneficiaries never received, said Lisa Dalga, state manager for the Senior Medicare Patrol.

“Information is the commodity of the 21st century,” said Moore, who advises beneficiaries to protect their Medicare numbers.

Along with those in New York, Indiana and Ohio, the directors of the Senior Medicare Patrol in Tennessee, Texas and Utah told KFF Health News that they had seen an increase in complaints about unwanted tests as the benefit deadline approached. .

Álvarez noted that test providers had “become more aggressive” lately, calling and emailing older people — something that do not do the legitimate representatives of Medicare—in addition to posting deceptive advertisements on the Internet.

When the covid-19 public health emergency ended on May 11, Medicare stopped paying for non-prescription tests, although it continues to cover those that are performed in a clinic, doctor’s office or in another health center and are processed by a laboratory .

Some private Medicare Advantage plans may continue to pay for in-home tests.

Medicare spent $900.8 billion in providing health coverage to 64 million beneficiaries in 2021. But the program loses up to $90 billion a year to fraudulent claims. Some of the more well-known scams have involved medical equipment such as electric wheelchairs.

Sara Lonardo, a spokeswoman for the Centers for Medicare & Medicaid Services (CSM), confirmed that Medicare received complaints about unsolicited tests, but said they came from only “a small portion” of Medicare beneficiaries who received tests.

Last year, the administration of President Joe Biden offered to all homes a limited number of free home tests, increasing access to testing as part of their effort to combat covid-19.

Later, in April 2022, CMS decided to pay for eight tests a month for those with Medicare Part B outpatient coverage, millions of seniors, one of the groups most susceptible to dying from the virus. Was the first time that the agency agreed to cover non-prescription and over-the-counter products at no cost to beneficiaries.

In a statement last monthfederal law enforcement authorities claimed that “violators allegedly tried to take advantage of the program by repeatedly giving patients or, in some cases, deceased patients, dozens of covid-19 tests they did not want or need.”

So far, Justice Department prosecutors have only confirmed one case related to the evidence scam.

A Florida doctor and a Georgia testing provider have been accused of illegally paying an unnamed Virginia marketing firm about $85,000 to obtain the numbers “of thousands of Medicare beneficiaries across the United States,” according to a complaint filed by the Department of Justice in April and obtained by KFF Health News.

The complaint alleged that this duo submitted more than $8.4 million in fraudulent claims for covid tests “regardless of whether Medicare beneficiaries had requested or needed the tests.”

Lampert would not say how many complaints the OIG received, adding: “There may or may not be other ongoing investigations that we can’t talk about yet.”

Details of various notices to beneficiaries about services received, obtained by KFF Health News, show that Medicare paid providers $94.08 for home covid tests using a billing code for “one test only.”

Most retail pharmacies sell a pack of two tests for about $24.

Lonardo said that Medicare paid up to $12 for a test and that the number of covered tests was limited to reduce “the risk of abusive billing.” He did not explain why the Medicare statements indicated a payment of $94.08.

Beneficiaries can be the best fraud detectives in preventing medical identity theft. Senior Medicare Patrol programs encourage them to review benefit summaries for any items or services that Medicare has paid for but never received.

If Medicare has paid for an item once, even if it was fraud, beneficiaries may not be able to get it when they really need it.

Diane Borton, 72, of New Smyrna Beach, Florida, has thrown away some of the expired tests she received that she never asked for, but she still has 25 left. She says she called the 1-1 helpline twice. 800-MEDICARE about the unwanted tests, but was told there was nothing that could be done.

Borton didn’t pay for the tests, but that’s not what he’s worried about. “I don’t want my government to pay for something that I’m not going to use and that I haven’t asked for,” he explained. “It seems like a waste of money to me.”

People with Medicare or private Medicare Advantage plans who receive unordered medical supplies can contact the Senior Medicare Patrol Resource Center at 1-877-808-2468.