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Medicare's Open Enrollment is Fertile Ground For Scammers - medtigo

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Medicare’s Open Enrollment is Fertile Ground For Scammers

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Jayanth Deshmukh, medtigo Medical News November 14, 2021

It’s difficult enough to choose the finest private Medicare drug or medical insurance plan among dozens of options without adding deceptive sales methods to the mix. 

Despite this, federal regulators claim that complaints are on the rise from seniors who have been duped into purchasing insurance that may not cover their medications or include their doctors without their authorization or based on shady information. In response, the Centers for Medicare & Medicaid Services has threatened to fine private insurance businesses that provide Medicare Advantage and prescription plans if they or their representatives mislead customers. 

It’s difficult enough to choose the finest private Medicare drug or medical insurance plan among dozens of options without adding deceptive sales methods to the mix. 

Despite this, federal regulators claim that complaints are on the rise from seniors who have been duped into purchasing insurance that may not cover their medications or include their doctors without their authorization or based on shady information. In response, the Centers for Medicare & Medicaid Services has threatened to fine private insurance businesses that provide Medicare Advantage and prescription plans if they or their representatives mislead customers. 

The person on the other end of the line said she required Heimer’s Medicare number to double-check that it was correct for the new card she was getting. “We’re not asking for a Social Security number, bank numbers, or anything like that,” the woman responded when Heimer hesitated. “It’s fine.” 

“I can’t believe I did that, but I gave her my credit card number,” Heimer added. The caller then inquired about her medical history before offering to send her a saliva test “for free.” Heimer felt suspicious and hung up at that point. She called the Medicare Helpline at 1-800-MEDICARE, as well as the AARP Fraud Watch Network Helpline and the Federal Trade Commission, to receive a new Medicare number. 

The phone called again later that morning, and this time the caller ID flashed a number that matched the toll-free Medicare hotline. She recognized the same woman’s voice when she responded. 

“You’re not a Medicare beneficiary,” Heimer told her. 

“Yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, Heimer hung up once more. 

It’s barely been two weeks since Heimer gave a stranger her Medicare number, and nothing has gone wrong. Scammers could use the number to bill Medicare for services and medical supplies that beneficiaries never receive, as well as sign seniors up for Medicare Advantage or prescription plans without their knowledge. 

According to Sandy Morales, a case manager for the group, accusations of fraudulent sales techniques for Medicare Advantage and prescription plans have been the top complaints to the state Senior Medicare Patrol for the previous two years. The patrol is a government-funded initiative that assists elders with insurance issues. 

According to Rebecca Kinney, director of the Administration for Community Living’s Office of Healthcare Information and Counseling at HHS, which oversees the patrols, the Senior Medical Patrol has sent 74 per cent more cases to CMS and the Health and Human Services Inspector General for investigation in the first nine months of this year than in all of 2020. 

Last month, CMS authorities cautioned private insurance businesses offering Medicare Advantage and prescription plans that fraudulent sales techniques are illegal under federal law. 

In a memo to insurers, Kathryn Coleman, director of CMS’ Medicare Drug and Health Plan Contract Administration Group, expressed concern regarding advertisements widely advertising Advantage plan features that are only offered in a limited area or to a limited number of beneficiaries. She also mentioned that CMS has received concerns concerning sales information that may be interpreted as coming from the government and pressure techniques used to encourage seniors to enrol. 

Coleman reminded the businesses that they are “accountable and responsible for their marketing materials and actions, including marketing performed on behalf of an MA plan” by sales reps. Companies that break federal marketing laws risk being fined or having their membership suspended. A CMS spokesman, however, was unable to provide examples of recent infringers or their punishments. 

Beneficiaries have one chance to move to another plan or to original Medicare if they uncover a problem before March 31, the end of the three-month disenrollment period each year. (Those who choose for the latter may be unable to purchase supplemental or Medigap insurance in all but four states: Connecticut, Maine, Massachusetts, and New York, with rare exceptions.) Unless they qualify for one of the few exceptions to the law, they are often tied into their Advantage or prescription plans for the whole year after March. 

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