The government spent nearly $950 billion on Medicare funding in 2022, according to the Centers for Medicare and Medicaid Services, but scammers claimed 6% of those funds that year, which equated to around $60 billion lost to fraud, according to the Department of Justice.
How does that happen? Medicare fraud comes in the form of unfamiliar charges on your Medicare account for items you haven't received or your doctor hasn't prescribed.
Roughly one in five Illinois residents is on Medicare. According to the Kaiser Family Foundation, the most recent data compiled in 2020 shows Illinois had the 7th-largest Medicare beneficiary population in the United States.
For retired nurse Linda Hennis, it was $15,000 worth of urinary catheters she didn't need and didn't order. She found 10 separate charges for them on her Medicare summary notice earlier this year.
"I've been on the giving end of urinary catheter, but never the receiving," Hennis said.
The charges came from a company called "Pretty in Pink Boutique" out of El Paso, Texas. When Hennis clicked on its website, she was met with a company disclaimer that perfectly fit her case.
"Up came the site with this huge disclaimer: 'If you're calling about urinary catheters, you may have been the victim of Medicare fraud,'" Hennis said.
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Apparently, this had happened many times before. According to the disclaimer, the boutique had received dozens of calls from people like Hennis, but it isn't the one billing Medicare for those items. The store doesn't even sell catheters.
The real culprits are fake companies registered with Medicare that share the name "Pretty in Pink Boutique." According to the disclaimer, there are at least five others.
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Travis Trumitch with the nonprofit AgeOptions calls these scam operations "shell companies" that "make their money and then get out real fast."
According to Trumitch, this is the way it usually goes: An overseas call center pulls a person's insurance information from the dark web or a data breach, calls the beneficiary to confirm that information, then sells it to a durable medical equipment company.
Trumitch said other devices, like knee or back braces, are often used in Medicare fraud. But catheters are most common.
When Hennis discovered the charges, she reported the scam to Medicare immediately. Although she wasn't billed directly, she knew she could face consequences down the road if she didn't.
"If your Medicare's billed for a device or equipment at some point and paid for, and then later on you legitimately need that, they can deny it," she said.
"It doesn't really hit the consumer unless they need it later in life," Trumitch said. "But it really hurts the American people because of all the tax dollars wasted."
Here's how you can avoid Medicare fraud:
- Beware of unsolicited phone calls asking to confirm your medical information. Medicare will not call you to ask for this information.
- Keep records of the medical services you've actually received.
- Monitor your Medicare summary statements, even if you have private insurance and receive "explanation of benefits" summaries. These notices can show you whether your insurance information has gotten into the hands of a scammer.
- Report Medicare Fraud here: https://oig.hhs.gov/fraud/report-fraud/
