Medical scams increasing on Cape Cod

Medicare scams are increasing in the U.S. at an alarming rate, as schemers use increasingly sophisticated ways to obtain patient and provider information in order to dupe them and the federal government out of billions of dollars. And, if you think Cape Cod is immune from this activity, think again.

“They’re getting smarter and smarter and it really is scary,” said Michael Jones, Cape Cod Healthcare’s Chief Legal Officer. “It’s happening in Cape Cod Healthcare’s world and we’re very concerned about it and want everyone to know about it and be aware.”

CCHC’s Legal Department is notified about attempted scams monthly, said Lynn Shields, Director of Clinical & Research Compliance, and those are only the incidents that are made known to them.

“We don’t know about the ones that go through (successfully),” she said.

CCHC will notify the FBI and other agencies when they see a new type of fraud, but the sophistication of the schemes usually makes it difficult to track them down, she said.

However, the federal government has had success in catching and prosecuting people and organizations. The Department of Justice announced in July that it had charged 36 defendants across the U.S. in a $1.2 billion healthcare fraud operation. The defendants, who included a telemedicine company executive, owners and executives of clinical laboratories, durable medical equipment companies, marketing organizations and medical professionals, were alleged to have engaged in fraud involving telemedicine, cardiovascular and cancer genetic testing, and durable medical equipment schemes.

The offer of medical equipment and tests are frequently used by unscrupulous scammers, who have somehow accessed patients’ Medicare or other insurance information and call them, so they will authorize the purchase, said Shields. Some scammers simply ask for a Medicare number and it is willingly provided because the caller is trying to be helpful. The scheme then proceeds to the doctor’s office, where the provider is asked to sign off on an order for the purchase.

One recent case of which CCHC became aware involved the offer of a piece of medical equipment to a patient, who thought it was legitimate and thought it could benefit them. Even though this particular patient didn’t need the equipment, it was offered at no cost and they thought it could be useful. An alert practice manager at the physician’s office, that was asked for authorization of the order via email by the scammer, looked at the request further. The email had a well-known drug store’s letterhead on it but, when the practice manager looked more closely, she noticed the numbers on the email were from different locations around the country - none of which were related to the drug store. When she called the numbers, there was no answer.

“If you try to call, they are either burner phones (cheap, prepaid mobile phones) or they are set up so they cannot receive incoming calls,” explained Jones.

In another instance, a local physician practice received a faxed request from a national drug store chain for a blood sugar monitor for one of their patients. When the practice staff looked further, they realized the patient didn’t use that pharmacy, the patient already had one of the devices and the doctor had not ordered another.

Examples of some other recent fraudulent activity include:

1. Fraudulent faxes to doctors’ offices from “pharmacies” requesting patient information.
2. Fraudulent calls from “mail order pharmacies” requesting information on patients.
3. Callers to patients impersonating Cape Cod Healthcare phone numbers and requesting medical information.
4. Fraudulent durable medical equipment (DME) requests submitted to physician offices without the patient’s knowledge. These orders often seek orders for items such as wrist or knee braces.
5. Fraudulent genetic screening requests submitted by companies without the patient’s knowledge.

Patients may also receive emails purporting to be from Cape Cod Healthcare. Patients should be aware that neither Cape Cod Healthcare nor Medicare will ever request that patients email medical and/or insurance information, said Shields.

“Typically, at a consumer level, most (legitimate pharmacy, insurance and medical supply companies) do not do business by email, unless (the patient) has initiated it,” added Jones. Medicare and insurances, unless expressly stated, do all official business through the mail, he said.

How to Protect Yourself and Medicare

To avoid becoming the victim of a Medicare/insurance scam, Jones suggested that you use what he calls the “tummy test,” when you receive a call or email asking for any medical/personal information or authorization.

“If there’s something about it that makes you uneasy in your stomach, you need to ask questions; you need to verify it,” he said.

Jones also advised:

1. Stop the conversation, if you are uncertain. Be aware that you are always in control of the situation.
2. When in doubt, take the caller’s name and number and call them back to verify they are who they say they are.
3. If you end the conversation and they keep calling you back, then the call may be legitimate. “What they don’t want you to do is end the conversation and they’re going to try to keep trying to trick you during that first conversation,” Jones said. “But they’re not likely to call you back if you end the conversation with them. So, make them call again. Make them do the work. Make them verify their identity.”

Jones suggested people print this story and tape the above three suggestions next to the home phone or in a prominent place, especially if there are people living in the home who have memory or cognitive issues.

Patients should also carefully review medical bills and explanations of benefits (EOBs) to make sure there are no suspicious charges or payments, advised Shields.

For more information and suggestions on how to deal with or report Medicare and other insurance/medical fraud, visit Medicare.gov, which has an online pamphlet: “Protecting Yourself & Medicare from Fraud” with 14 tips to help prevent fraud.

To report a Medicare fraud issue, call the main number at 1-800-MEDICARE (1-800-633-4227).