February 11, 2019

We were recently told about a person who approached staff at an agency serving veterans offering a free dental resource for veterans. They claimed that with their program, Medicare would cover up to $1,000 for dental services and $25 each month of over the counter drugs with no cost to the veteran. 

Sound too good to be true? That’s because it is. Here is what was actually happening: this person was an insurance agent and they were selling a Medicare Advantage plan that included dental coverage. If a veteran signed up for the plan, they would lose their Part D coverage (while many Advantage plans include prescription drug coverage, this plan did not), be restricted to the plan’s network of doctors, and lose any Medicare Supplement plan they might have. Medicare Advantage plans work well for some people, but by only referring to this as a dental program, the agent was not giving people enough information to make an informed decision. 

If you think you might want to change your Medicare coverage, be sure to Ask the Right Questions (also available in Spanish). There is also free, unbiased help available from your local SHIP counselor. In Illinois, call (800)252-8966 to find a SHIP counselor near you.  

A clinical psychologist in Chicago was recently charged in a federal indictment with participating in an alleged scheme to defraud Medicare of about $3.2 million. This doctor allegedly submitted fraudulent claims to Medicare for psychological services to “severely mentally disabled adults living in community-based housing…. that were never performed, and for services performed on a routine, rather than an as-needed basis.” Read more in this Department of Justice press release. 

The best way to detect fraud is to always read your Medicare Summary Notice or Explanation of Benefits from your insurance company and watch out for services that you did not receive or other billing errors. You have the right to ask your doctor about the services you are receiving. 

This is the first Fraud Alert of the new year, and that’s not all that’s new! This message is coming to your inbox from a name that might new to you. Travis Trumitch (pictured right) joined AgeOptions as the statewide SMP Coordinator in August 2018 and future Fraud Alert emails will come from him. You may also notice that the Fraud Alert has a new look. This new format is meant to be easier to print and to read on mobile devices. We hope that you’ll share these Fraud Alert emails and their fraud prevention message with your network or print them to post on public bulletin boards. Finally, if you are wondering where our “Fraud in the News” section went, then head over to our Illinois SMP Facebook page where we are posting healthcare fraud related news, prevention tips and more. 

Our Fraud Alert emails will continue to highlight healthcare fraud trends, scams or news that affect Medicare beneficiaries in Illinois. We look forward to bringing you more Fraud Alert emails in 2019 and welcome your feedback.