Protect yourself: Medicare scams and how to avoid them

Capital Blue Store

The arrests of 11 individuals in connection with an alleged $10 billion Medicare fraud case serves as an important reminder to review your insurance statements and guard your personal information.

This case is not an isolated incident – healthcare fraud costs the U.S. billions every year. Capital Blue Cross has seen an uptick in fraudulent claims involving durable medical equipment (DME) like diabetic supplies, urinary catheters, and knee braces, said Chief Medical Officer Dr. Jeremy Wigginton.

Technology and an aging population are making it easier for scammers to exploit Medicare, and the scale and sophistication of the scheme highlights just how important it is to be on the look-out.

“They talk the language; they know medical lingo; and they’re very persistent,” Dr. Wigginton said. “Once they have your information, they can submit false claims for services or equipment that were never provided or needed.”

Tips to protect yourself against health insurance scams

Capital Blue Cross has a dedicated team that works with local, state, and federal law enforcement to detect, report, and prevent healthcare fraud. Their work has identified millions of dollars in fraudulent claims.

Dr. Wigginton said preventing these scams takes everyone’s help, including Capital members. Here are tips to avoid scams:

  • Protect your information: Never give out your personal information such as birth date, social security numbers, Medicare number or health insurance number.
  • Ignore unsolicited offers: If you are unsure that the call is real, ask for the person’s phone number and tell the person you will call them back.
  • Verify with your doctor: Ensure that any durable medical equipment (DME) is prescribed by a doctor who has personally assessed your condition. If you are offered medical equipment or services that you did not ask for or do not need, decline the offer.
  • Avoid suspicious links: Scammers often send emails or texts that look official, like they’re from Medicare or Capital Blue Cross. If you don’t recognize the source, or the message looks suspicious, don’t click the link.
  • Check insurance statements: Monitor your Medicare statement and your explanation of benefits (EOB) from Capital Blue Cross for services that you never received.

If you receive unrequested medical equipment or suspect fraudulent activity, report it right away. Capital Blue Cross has an anonymous fraud phone hotline – (888) 612-1277 – or an online form to report suspicious activity.

This is not medical advice and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition or treatment. The information provided is meant for a general audience. Capital Blue Cross and its affiliated companies believe this health education resource provides useful information but does not assume any liability associated with its use.