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The manager of Area 1 Agency on Aging's Health Insurance Counseling and Advocacy Program is alerting the community to potential Medicare fraud by two 30- to 40-year-old males making unsolicited phone calls and home visits to talk to seniors about Medicare.
A Eureka woman suspicious of the pair reported the incident last week to the Health Insurance Counseling and Advocacy Program, manager Martha Johnson said.
”They had no identification and didn't say who they were representing,” Johnson said Wednesday. “It's a scam.”
Johnson said one of the current ploys is to tell people that with health care reform, Medicare is offering them something new they'd like to talk about.
In reality, she said, Medicare's marketing guidelines do not allow home visits or phone calls unless you have given the company permission for the visit or requested a call, and by using language that leads someone to believe the representative is from Medicare, they open that door.
”Medicare does not make home visits,” Johnson said. “The people are not with Medicare.”
Johnson said seniors who get a visit or call from these men should notify HICAP at 444-3000 after trying to get a name, a business card or other useful information.
”Don't feel pressured. With someone you trust, take the time to go over anything they leave with you,” she said. “Don't sign your name to anything -- even if it's for a free gift, because then they have your signature. And don't show them your Medicare card.”
Johnson said she worries it is not an isolated incident. The Eureka caller told HICAP that the men, dressed in suits, had to re-schedule their initial appointment a few times, the last because of conflicts with appointments in Trinidad.
”It sounds like they are visiting a number of people up here,” Johnson said.
The goal could be to gain access to a Medicare account and a signature to enable fraud. The purpose could also be to sell Medicare Advantage plans, which are health insurance options approved by Medicare, run by private companies, and sold by agents on commission.
”They may tell you the plan is a Medicare Supplement Plan and it will not affect your original Medicare, but that's not true,” Johnson said. “An Advantage plan replaces original Medicare and becomes your primary health coverage.”
Although the enrollment deadline for Medicare's Part D prescription Drug plan has passed, Medicare gives recipients until Feb. 14 to drop any Medicare Advantage plan and re-enroll in original Medicare.
”If someone did sign up for an Advantage plan and they are not comfortable, they have two weeks to change,” Johnson said. “If they feel there was fraud or misrepresentation, or if they didn't understand what they were signing up for, they need to call us.”
Johnson also referred people to the Medicare Fraud Tool Kit at www.aging.ca.gov/resources/FraudToolkit_EYS_1-25_CB_edits.pdf . This eight-page kit includes a fact sheet, forms for you and the visiting agent to complete for your records, questions to ask, red flags and steps to follow to protect Medicare accounts.
”So many choices can be confusing and could increase the potential for misleading, fraudulent or abusive sales practices,” states the introduction on Page 2 of the kit developed by HICAP, the California Department of Aging, California Senior Medicare Patrol and California Health Advocates. “We know how important Medicare is to you and we want to help you protect it.”
The kit also directs people to HICAP for “free, unbiased and confidential counseling on your health care benefits.”
HICAP serves 22,000 people in Humboldt County and 5,000 in Del Norte County. Trained counselors offer free appointments to Medicare beneficiaries and families to assist in understanding all areas of health insurance, how other programs relate to Medicare, and how to qualify for extra help in paying for health care.
”We're here. We can help. But you have to call,” Johnson said.
The A1AA and HICAP office is located at 434 Seventh St. in Eureka and can be reached at 444-3000.
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