Medicare Identity Theft

Medicare Identity Theft is a serious and growing problem that impacts the lives of millions of seniors every year. A variety of reasons, including the expansion of technology and the Internet, allow personal information to be stolen and sold worldwide. Furthermore, the sheer magnitude of Medicare provides both incentive and opportunity for thieves to take advantage of the program. Medicare serves 46 million beneficiaries, who are primarily seniors, and expends $375 billion annually. Because it is so large and complex, with thousands of health care providers submitting millions of claims daily, Medicare is difficult to oversee. As a result, $68 billion is estimated to be lost to fraud annually.

The loss of a senior’s Medicare card or Social Security card (Note: both numbers are the same) immediately puts the senior at risk. While Social Security will replace the Medicare or Social Security card, it will not issue a new number. When this valuable identification falls into the wrong hands, the senior will be at risk of being victimized for the rest of his or her life.

What risks might the senior be exposed to from identity theft? Theft and misuse of a beneficiary’s Medicare number can lead to false claims being filed under that number and can impact the beneficiary with staggering medical bills, maxed-out benefits and compromised medical history records.

In a report about medical identity theft, Pam Dixon, Executive Director of the World Privacy Forum (WPF) pointed out, “Victims of medical identity theft may receive the wrong medical treatment, find their health insurance exhausted, and could become uninsurable for both life and health insurance coverage.” She warned, “Changes made to victims’ medical files and histories can remain for years and may not ever be corrected, or even discovered, which can have deadly consequences.”

A different blood type, incorrect reports of substance abuse, someone else’s lab test results, wrong history of illnesses — think about the serious consequences any one of these could have for the victim of medical identity theft.

What should seniors do to protect themselves from shattering financial loss and personal harm? The primary protection is to exercise extreme vigilance and caution on all matters relating to Medicare and personal identification, such as Medicare number, Social Security number, birth date, birthplace, and mother’s maiden name. Here are some precautions that will minimize risk:

• Keep a record of doctor visits, hospital visits and medical supplies and equipment purchases. The Senior Medical Patrol (SMP Hawai‘i) has a Personal Health Care Journal for that purpose. Call 586-7319 or 1-800-296-9422 for a copy.
• Check the Medicare Summary Notice (MSN) or Explanation of Benefits (EOB) for possible errors. If there is a mistake in the Medicare statement or another billing issue, call SMP Hawai‘i for assistance. All that may need to be done is to call the provider to correct the error. If concerns remain, SMP Hawai‘i staff and certified volunteers will assist.
• Always safeguard your Medicare card. Be careful not to give out the number to anyone questionable.
• Do not accept money or free gifts, products, or services in exchange for the Medicare number.
• Beware of persons that claim to be from the government and ask for personal information or money. Try to get their name and phone number. Report the contact to SMP Hawai‘i.
• Be informed about beneficiary’s rights under Medicare, including access to medical records, statements of services received, and appeals of unfavorable decisions.

In summary, Medicare identity theft is a real and growing threat to seniors’ wellbeing and Medicare’s sustainability. Seniors are the best front-line defense to detect, prevent, and report Medicare identity theft. To perform that role, they need to keep informed and be proactive.

“Who is the Senior Medicare Patrol (SMP Hawai‘i)?”

In 1997, through Public Law 104-208, the U.S. Administration on Aging established 12 grant-funded demonstration projects to recruit and train retired professionals to identify and report error, fraud and abuse related to Medicare. Hawai‘i received one of the original 12 grants, and named its Senior Medicare Patrol project, “SageWatch.” Now, “SMP Hawai‘i,” the project is based in the State Executive Office on Aging.

SMP Hawai‘i has volunteers on Kaua‘i, O‘ahu, Maui, Moloka‘i and Hawai‘i. The volunteers engage in educational outreach about Medicare fraud by disseminating information at community events and group presentations. Currently, SMP Hawai‘i is conducting a statewide media campaign to recruit volunteers and to reach Cantonese, Ilocano, Tagalog and Vietnamese populations in Hawai‘i. You may have seen SMP ads in Generations Magazine and RSVP newsletters and heard SMP radio announcements on KNDI, ESPN 1420/1500, and Hawai‘i Public Radio. In the works, is a volunteer recruitment public service announcement for TV.

For more information, contact Senior Medicare Patrol (SMP) program:
 www.smpresource.org | 808-586-7281 | 1-800-296-9422 (toll-free)

For presentations, resource materials or a volunteer application packet, call: 808-586-7319