How to prevent health care fraud


Each year, thousands of older adults become victims of health care fraud, billions of dollars are lostand those losses are passed on to individuals and families. Family caregivers are one of the most important tools in combating this type of fraud. Being aware of the types, signs of fraud and prevention strategies are the first steps.

Types of health care fraud

There are many types of fraud, but a few of the most common are:

• Identity theft. This happens when someone uses another person’s Social Security number to access Medicare, Medicaid or private health insurance benefits.

• Medical equipment fraud. This happens when nonessential medical equipment is recommended and obtained using Medicare, Medicaid or private insurance.

• Billing for services not provided. This happens when a health care provider bills for services that were never provided and may include office visits, laboratory visits or diagnostic tests.

• Direct medical marketing. This happens when unnecessary medical services and products are marketed directly to consumers — often through unsolicited phone calls, mailings or email advertisements.

Signs of health care fraud

Neighbors, friends, caregivers and family members are critical in identifying signs of fraud. The following are common signs or indications of vulnerability to fraud:

• Unnecessary medical equipment or medical services. If medical equipment seems to be piling up or tests seem excessive, this may be a sign of fraud.

• Long-term illness. Chronic conditions, including cognitive impairment, can impact a person’s ability to properly review the billing statements or keeping up with insurance claims. It may mean that others step in to help with filing, following up and reviewing medical documents.

• Miracle cures. These “cures” may be in the form of special equipment, supplements or natural substances that will reverse long-standing chronic conditions.

Tips for fraud prevention

The old adage that “an ounce of prevention is better than a pound of cure” is certainly true when it comes to health care fraud. Prevention may be in the form of:

• Asking questions. Questions are the first step to identifying possible fraud. Don’t be afraid to question a professional if you feel something is not right. If something seems a little off, trust your judgment and take action. It may be as simple as a small mistake that can easily be corrected.

• Reaching out to Senior Medicare Patrol Hawaii. SMP Hawaii trains volunteers who offer community presentations, information at community fair tables and even one-on-one individual counseling. This program is provided by the Executive Office on Aging and volunteers are Maui residents. Contact SMP Hawaii by calling (800) 296-9422.

• Searching the internet for local fraud prevention resources. A simple search of “Maui Elder Fraud Prevention” brought up a list of community town hall meetings, an Elder Abuse Awareness Booklet from the Maui County Office on Aging, a fraud prevention guide from the Department of Health, state elder abuse hotlines and much more.

• Protecting private information. Social Security numbers and medical cards (Medicare, Medicaid and private insurance) should all be protected as carefully as credit cards, ATM cards and personal checks. This information should never be provided to strangers.

• Keeping track of medical appointments. One of the tools that SMP Hawaii volunteers provide at community fairs and presentations is a medical records tracker. In this little booklet, older adults and/or their caregivers record the date, purpose and outcome of each medical appointment. It is a wonderful tool to keep medical information in one place.

• Reviewing bills and statements regularly. A medical appointment tracker can help patients and families reconcile bills and statements. If the two do not agree, contact the health care provider and the insurance provider (Medicare, Medicaid or private insurance).

Awareness and prevention are the greatest tools for reducing fraud in general, but especially health care fraud targeted at Maui’s older adults. Take a simple step today by sharing this information with another person in your family or neighborhood.

Note: Information for this article was taken from the University of Hawaii at Manoa ‘Ohana Caregiver website/ publications and the SMP Hawaii website.

* Heather Greenwood Junkermeier is with the University of Hawaii at Manoa Cooperative Extension, Maui Intergenerational and Aging Programs. Aging Matters covers topics of interest to the aging Maui community and appears on the third Saturday of each month.


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