May 22, 2018
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Elders help fight Medicare fraud, abuse

By Carol Higgins-Taylor, Special to the BDN

Medicare fraud costs taxpayers billions of dollars a year. It is estimated that $1 out of every $7 spent by Medicare is on fraud, errors, waste, and abuse.

The federal government is cracking down on abusers, but the government can’t do it alone. They need the help of all Medicare beneficiaries. There is good news, however. It has been reported that more than $8 is being recouped for every $1 spent on the crackdown in 2013.

“The consumers are the front-line defense,” said Betty Balderston, statewide coordinator for the Maine Senior Medicare Patrol (SMP). “They are the only ones who really know, along with the provider, if the service billed to Medicare was actually received. Nationally the SMPs have helped recoup $112 million since their inception in 1997.”

Preventing Medicare fraud begins at home; SMP advises beneficiaries to “Protect, Detect, and Report”:

• Protect your Medicare number. Treat it like a credit card. Never give the number out over the phone unless you initiated the call or to someone who comes to your door claiming to need it. If your card is lost or stolen, report it immediately to 1-800-MEDICARE.

• Be alert to people who claim to know how to bill Medicare to get payment even if an item or service is not covered. This is a scam and should be reported.

• Don’t accept free medical services or equipment in exchange for your Medicare number. Nothing is ever free. Unscrupulous providers or scam artists will later bill Medicare for things you may have never received.

• Detect fraud, errors, waste and abuse by monitoring your Medicare statements. Carefully look at each entry to be sure the service listed was provided.

“I tell people to think of their Medicare statement like a credit card statement,” said Balderston. “People don’t think of it as ‘their’ money being spent, but it really is. The cost belongs to all taxpayers.”

• Report anything that looks suspicious on your statement. Contact the provider first, because it may be a simple mistake. But don’t be put off. Balderston said she has had people report that when they called the provider, they were told “not to worry about it.”

“But they should worry about it, we all should,” she said. “Errors, fraud, waste, and abuse add up to billions of dollars being lost in the Medicare program.”

• If you don’t receive satisfaction from the provider’s office, then report your suspicions to SMP, which has volunteers and staff at each area agency on aging. Information will be gathered, and the complaint will be forwarded to special investigators who contract with Medicare.

And every complaint is taken seriously.

While some beneficiaries tried to report an instance of alleged fraud directly to Medicare only to be told that the complaint wasn’t “big enough” the situation is changing.

“Reporting to SMP will generate action on the complaint,” said Balderston.

For more information on SMP, call Eastern Area Agency on Aging.

On another note, I do want to remind you that April 9 is the deadline for the discounted price on the Collette vacations tour, “Memorials of War: Normandy and Paris.” The trip departs Oct.9 and returns Oct. 18. If you book through EAAA, you will have the peace of mind of leaving your car in the agency parking lot while you are ferried to your flight.

You’ll visit Paris, the small commemoration garden close to the Bir Hakeim Bridge, Pointe Du Hoc Ranger Memorial, Omaha Beach, Omaha Memorial Museum, the U.S. Military Cemetery and Utah, the westernmost of the Allied landing beaches. Then, it’s off to St. Mere Eglise, Pegasus Bridge, and the medieval town of Chartres.

This is the trip of a lifetime. If you are interested, give Noelle Merrill at EAAA a call.

Carol Higgins Taylor is director of community education at Eastern Area Agency on Aging. For information on EAAA, call 941-2865, toll-free (800) 432-7812, or log on

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