Avoiding Medicare Marketing Scams – Fraud and Abuse

by Mary Jane Stern

The 2010 Medicare Marketing Season runs from October 1^st through December 31^st and the Centers for Medicare & Medicaid Services (CMS) is very specific on how Parts C (Advantage Plans) and Part D (Prescription Drug Plans) can be marketed.

One area of concern is marketing through unsolicited contact.  What does this mean?  According to Federal Regulations, it is prohibited to make contact with any Medicare beneficiary occurring outside of any advertised sales or educational events.  Here are a few examples of what is prohibited:

• Door to door solicitation – coming to your home without an invite
• Approaching you in a parking lot, hallway, lobby, etc.
• Unsolicited telephone contact
• Unsolicited emails (unless you have given out your email address)

However, companies are allowed to market via direct mail and other media print as long as they are in compliance with the marketing rules and regulations.   If you are receiving direct mail take note, because the mail must include one or all of the following:

• Advertising  pieces – “This is an advertisement;”
• Plan information – “Important plan information about your enrollment; and
• Health – “Health or wellness or prevention information.”

It’s unfortunate, but there are many scams out there targeted towards seniors and the elderly.  Understanding what is allowed and what isn’t allowed will only help you figure out who is “for real” and “what might be a scam.”

Question everything; don’t get caught up in the marketing, or by the master sales person.  Medicare advises the following and it is recommended you write everything down:

Be suspicious of providers that:

• Charge co-payments on clinical laboratory tests, and on Medicare covered preventive services such as PAP smears, prostate specific antigen (PSA) tests, or flu and pneumonia shots.
• Routinely waive co-payments on any services, other than those previously mentioned, without checking your ability to pay.
• Advertise “free” consultations to People with Medicare.
• Claim they represent Medicare.
• Use pressure or scare tactics to sell you high priced medical services or diagnostic tests.
• Bill Medicare for services you did not receive.
• Use telemarketing and door-to-door selling as marketing tools

If you feel you have been a victim of any Medicare abuse or fraud, you need to contact the Office of Inspector General Hotline.  This hotline is a confidential way for you to report vital information. The Hotline can be contacted:

By Phone:     1-800-HHS-TIPS (1-800-447-8477)

By Fax:     1-800-223-8164
(no more than 10 pages please)

By E-Mail:               HHSTips@oig.hhs.gov

By Mail:     Office of the Inspector General
HHS TIPS Hotline
P.O. Box 23489
Washington, DC 20026

You can also report suspicions of fraud and abuse to the Medicare’s Customer Service Center at 1-800-MEDICARE (1-800-633-4227).

Please be careful and ask plenty questions.

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