More than any other demographic, older adults fall prey to scams. The Federal Trade Commission reports that between 2020 and 2024, losses between $10,000 and $100,000 among people over 60 increased more than fourfold, and losses exceeding $100,000 increased more than sevenfold. Medicare, the nation’s health insurance system for people 65 and older, has become a popular program for criminals to mine at the expense of beneficiaries and the program itself.
The non-profit California Health Advocates (CHA) is charged with investigating Medicare fraud complaints that come in through a national hotline. Rose Morales is a senior fraud investigator with CHA, one of the Senior Medicare Patrol (SMP) organizations that empower Medicare beneficiaries. The organization works with their families, and caregivers to prevent, detect, and report healthcare fraud, errors, and abuse to federal authorities like the Office of Inspector General (OIG) and Centers for Medicare & Medicaid Services (CMS).
“The biggest issue now is deceptive hospice enrollment,” Morales said. “Medicare beneficiaries are being enrolled into hospice without their knowledge or permission, even though they are not terminally ill.”
In at least one case, scammers posed as nurses and wandered into the cafeteria of an apartment complex and talked residents into signing up to qualify for free items they need such as protein shakes, toilet paper and paper towels.
“I had the daughter of one beneficiary whose father is a kidney transplant patient, does not speak English and needed Medicare. But he was enrolled in hospice, and his medications had been stopped.”
Rose Morales
Senior Fraud Investigator, California Health Advocates
“The beneficiaries say, ‘Here, this is my ID and Medicare card,’ and they sign a hospice program enrollment form not knowing that it says ‘hospice facility’,” Morales said. “They don’t explain to the beneficiary that if they enroll in hospice, they must only have six months left to live.”
The scammers use the victim’s personal information to enroll them in hospice care, then bill Medicare for reimbursement for services that were never provided.
Victims are alerted to the fraud when they try to pick up prescriptions, or they call their doctor to make an appointment, only to learn that they can’t do either because they are enrolled in hospice. The results can be life-threatening.
“I had the daughter of one beneficiary whose father is a kidney transplant patient, does not speak English and needed Medicare,” Morales said. “But he was enrolled in hospice, and his medications had been stopped.”
Morales said when beneficiaries learn that they’ve been duped, they are often afraid to come forward or admit they’ve been tricked by a scammer. The beneficiary is often so shaken by their experience that they are afraid to speak with an SMP investigator. In these cases, Morales tells them to call 1-800-Medicare and confirm that CHA is one of the Senior Medicare Patrol agencies under the Administration for Community Living.
Once SMP confirms the fraudulent activity, investigators like Morales work with Medicare to dis-enroll the beneficiary from hospice. Occasionally, investigative calls to hospice programs reveal that the beneficiary also has been unknowingly signed up for home health care services.
Other common scams against Medicare beneficiaries include orders for durable medical equipment, such as orthotics, knee or back braces, all of which must be prescribed by a physician. In these cases, a scammer has called them posing as a Medicare representative and asked them to provide their Medicare number to complete the equipment order.
The beneficiary doesn’t realize they have been scammed until they see their Medicare Summary Notice detailing all medical services, supplies, and equipment billed to Medicare in their name.
Beneficiaries will later complain that they had once had a back injury, but don’t need a back brace or that they need a knee brace, but don’t recognize the doctor’s name on the notice.
“I tell the beneficiary to contact 1-800-Medicare, so they have a record of it,” she said. “I gather all of the information and attach it to the case.”
Medicare card scams are common, as well. Fraudsters will call beneficiaries, claiming they want to verify their Medicare information so that they can send them a new card or to confirm their Medicare number.
“We always advise beneficiaries to keep track of the Medicare Summary Notice (MSN) or the Explanation of Benefits (EOB) and write down the dates of their doctor visits so they can confirm the services.”
Morales also advises all beneficiaries never to talk to anyone who calls saying they are from Medicare.
“Just hang up,” she said. “Medicare will not call. They send letters.”
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