Understanding health care fraud


Health care fraud is widespread. Each year, it causes thousands of older adults to become victims and billions of dollars to be lost by Medicare and Medicaid.

As a family caregiver or someone on Medicare, you are in a unique position to protect your loved ones from health care fraud. You can also help lower health care costs for everyone by preventing health care waste and abuse.

This article describes some easy and effective steps you can take to reduce health care fraud, waste and abuse.

Common types of health care fraud include:

• Medical equipment fraud: When a health provider recommends a piece of equipment that is not really necessary, such as a power chair or a home hospital bed.

• Cold call solicitations: When someone selling a health care product, service, or health plan makes a phone call or home visit without an invitation.

• Identity theft: Unauthorized use of Medicare or Social Security numbers.

• Billing for non-rendered services: When a health provider bills for services that were not performed, such as an extra office visit or test.

• Up-coding: When a health provider bills for more costly services than delivered, such for a specialized test when only a routine exam was performed or charging for better quality equipment than provided.


While some older adults may not realize they need help, others may feel uncomfortable asking for help because it may reflect a loss of independence. Family caregivers need to be aware of signs that an elder might need help.

These signs may be:

• Severe illness or long incapacitation: When people are ill, they spend their energy on recovering, often at the expense of insurance and money matters.

• Cognitive impairment: Problems with memory can interfere with decision-making abilities.

• Unnecessary services, supplies, or equipment: Medical procedures, supplies, or equipment that does not seem necessary may be a sign that your loved one is a victim of health care fraud.

• Miracle cures: Unusual medical equipment and miracle “potions” may also be a sign of health care fraud.

• Consultations with dubious professionals: Properly trained, honest health care professionals do not push their patients to purchase questionable items.


Protecting your loved ones’ personal information is the best line of defense in the fight against health care fraud and abuse:

• Treat your loved ones’ Medicare, Medicaid and Social Security numbers like credit card numbers. Never give these numbers to a stranger.

• Beware of people who claim to represent Medicare and try to sell you something. Medicare does not call or visit to sell products or services.

• Don’t carry information you do not need. Take your Medicare card only to places where you will use it such as the doctor’s office, hospital, clinic, or pharmacy.

• Examine your Medicare Summary Notices and Part D Explanation of Benefits when you receive them. Shred these documents when they are no longer useful.

• Record doctor visits, tests and procedures in a personal health care journal or calendar.

To learn more about health care fraud, visit UH Manoa’s Ohana Caregivers website to watch “Be Akamai About Healthcare Fraud” and listen to interviews with the Hawaii Executive Office on Aging at bit.ly/2sqr5D1. To explore the other topics on the Ohana Caregivers website, visit www.hawaii.edu/ohanacaregivers.

* Today’s column was guest written by Dr. Lori Yancura and Pamela Chow, retired extension educators. Aging Matters covers topics of interest to the aging Maui community and appears on the third Sunday of each month.