I wrote recently about fraud and its huge impact on healthcare costs.  It costs you and me $80 billion a year, according to an FBI estimate!

Cost, however, can be measured in all sorts of ways.  Consider the emotional and cultural toll fraud takes when you know that the elderly are a prime target.  The other day, I saw that financial scams against the elderly are considered “the crime of the 21st century.”  (Sorry, but this includes you, too, Dad.)

HOT TIP:  Want to catch healthcare fraud against the elderly before it happens?  Then steer clear of free-standing, rolling labs.  Fake or unnecessary the tests offered by such scams are often billed to insurance or Medicare.

HOT TIP: Want to catch healthcare fraud against the elderly before it happens? Then steer clear of free-standing, rolling labs. Fake or unnecessary the tests offered by such scams are often billed to insurance or Medicare.

Who is targeted and why?
Here’s a quick look at two big reasons why our elderly are so often victimized: 

  • Most senior citizens are likely to have a nest egg. This makes them attractive to con artists.  However, low-income adults are also at risk.
  • Most elderly victims were raised to be polite and trusting. Not only are they therefore more likely to comply with their perpetrator, seniors less likely to report fraud because they’re embarrassed.

Plus, there are more and more seniors and targets available, as our society ages.

What does healthcare elder fraud look like?
Here are some of the things to look for:

  • Medical equipment is a big source of potential fraud and abuse.  Watch out when equipment manufacturers offer “free” products.  Insurers are then often charged for products the individual may not have needed or may not have been delivered.
  • “Rolling Lab” schemes are another way our elderly and providers are victimized.  This is when unnecessary or fake tests are given to the elderly at retirement homes, shopping malls, or drug stores and then billed to insurance companies or Medicare.  Sometimes individuals are billed for services never rendered by changing bills or submitting fake ones.
  • Medicare fraud is a biggie as well, and the elderly are frequently targets.  Because physicians must sign documents certifying that equipment or testing is needed before Medicare pays for it, con artists may forge signatures or bribe doctors to sign them.  Once the form is signed, the manufacturers bill Medicare for merchandise or services that were unnecessary or never even ordered.

How do we protect the elderly against fraud?
Here’s some practical advice, based on years in the field:

  • Keep track of healthcare records and equipment or tests received.
  • Review your explanation of benefits and call for discrepancies or questions.
  • Ask medical providers what your charges will be and what to expect to pay out-of-pocket.
  • Be picky who you give your insurance or Medicare ID to.
  • Be wary of door-to-door or telephone medical equipment salespeople.
  • Don’t give blanket authorization to medical providers to bill for services rendered.
  • Never ever sign blank insurance claim forms.

Unfortunately, this is only the tip of the iceberg.  So, stay sharp!

Jordan Ilderton, RN, BSN, is a Legal Nurse Consultant with MKC Medical Management.  Contact Jordan at jordan@mkcmedicalmanagement.com or at 865-551-6800.