How to Spot a Health Insurance Scam
Health insurance scams are on the rise in light of recent changes in the law concerning Medicare beneficiaries. Some of the changes include the choice to ditch traditional Medicare and participate in the Medicare Advantage plan allowing prescription drug and medical coverage through a private insurer. As a result fraud and in some cases criminal activity has been detected in cases involving the elderly.
The problem with Medicare Advantage begins with sales people making a commission of $400-$500 per person they sign up to the plan. With the potential to make that much money in one quick sale, some see it as an incentive to commit fraud. The Estys of Wilmington, North Carolina experienced one such case when a salesman with Humana came to their home offering a government subsidized Medicare Advantage plan.
When the couple left the offer as undecided, the salesman left their home. The next time Mrs. Esty went to buy her husband’s medications, she learned that the representative had signed her up for the plan without her approval or without telling her. Part of the problem is that the laws are not strict enough when it comes to enrolling people in this particular plan, although help can be obtained through local offices of State Health Insurance Assistance Programs and state attorney general offices. Another form of fraud has been through the use of bogus drug discount cards, where some criminals are obtaining patients’ bank account information over the phone when making sales.
Perhaps the worst cases involve elderly patients with dementia. A company in Florida was found to have sold home health care plans to 44 victims at $2000-$4000 per person. The best way to avoid these crimes is for the elderly to send copies of financial statements and policies to trusted friends or family members.
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