<New Fraud Scam to Medicare>

New Fraud Scam Found

in Spanish-Speaking Communities

Senior Medicare Patrol (SMP) project has found a 'new strain'

of Medicare fraud cases in Southern

California's primarily low-income Spanish-speaking communities. This new activity is particularly insidious as it targets the vulnerabilities of a particular ethnic group and socio-economic class, and plays off of SMP's educational outreach on Medicare fraud. Below are a few synopses of three recent cases, all of which have been reported to Medicare's fraud unit.

A Latina woman on Medicare who had received several foot surgeries in the past year and who's doctor had referred and provided transportation for her to see many specialists in the Los Angeles area, did not think it strange when she received a phone call saying that her doctor wanted her to view some test results. The caller said someone would pick her up at home the following day to bring her in to the clinic. This arrangement seemed fine until, after being picked up, she was driven 20 miles away and taken to an unfamiliar clinic where no one spoke Spanish. On top of that, no test results were shown to her. Instead she was forced to have a barrage of unnecessary tests that could then be billed to Medicare! She gave blood and urine samples, had x-rays and an ultrasound taken. The whole time she recalls screaming at them to stop but no one listened. After being taken home, she called CHA's SMP project.

A Spanish-speaking man, who takes a large number of medications for his heart condition, received a call at home from the "Medicare Fraud Unit." The caller told the beneficiary that they were concerned his doctor was 'over' prescribing medication as a way to defraud Medicare and that they needed him to come to their clinic for some tests. The beneficiary was shocked and agreed to be picked up at home the next morning. Like the woman mentioned previously, this man was also driven about 20 miles away to a clinic where only the receptionist spoke Spanish. He was similarly forced to take number of tests, and was even given some sort of 'allergy injection.' He was then sent home with a "bag of gifts" and one prescription, supposedly to replace the many drugs his doctor had been prescribing for him. It turns out the one prescription was a just a combination of fosamax (a drug for treating osteoporosis) and some over-the-counter medicines. This man also called CHA's SMP.

Outside of a Save-On pharmacy, several Latinas seniors, were approached by some men across the street from their senior residence apartments in Southern California. These men said that if the women had Medicare, they could receive several "free" tests. The women were told they would be picked up the next morning. Like in the previous cases, these beneficiaries were also driven to a clinic about 20 miles away, given several tests, and were sent home with a 'prescription' of unlabeled pills that they were told to take. Upon hearing of this incident, the director of the senior residence called the SMP project.

These examples represent some of the common threads of this new method of fraud. In most cases, beneficiaries are called at home - receiving a call either from "Medicare" or the "Medicare Fraud Unit." Wen Daniels, CHA's Community Outreach Coordinator in the SMP project, notes that these 'con-artists' have "caught on that we're educating seniors on fraud….They're incorporating our outreach efforts into their fraudulent" schemes. People committing fraud are "very inventive" and "constantly tweaking" their strategies.

The second and third cases mentioned are also examples of beneficiaries being given medication that may or may not be appropriate for them. In the case of the man, he is a cardiac patient with several medications that he must take regularly as a part of staying healthy. If he had believed the doctors at the 'testing' clinic, he may have stopped taking the medically necessary drugs prescribed by his doctor and may have had serious health consequences as a result.

Also, in all of the mentioned cases, beneficiaries were picked up from home, driven to a site miles away, and given many unnecessary tests. As transportation is a challenge for many elders in low-income Spanish-speaking communities, and the people committing Medicare fraud are using this hardship to their advantage. In other high-income communities, where transportation is not an issue, beneficiaries may be more suspicious of this kind of ride offer.

Because new fraud schemes tend to spread fast, Daniels and SMP Project Coordinator, Anne Gray, recently traveled to Fresno to educate Fresno's large Spanish-speaking farming communities about this fraud tactic as part of their ongoing SMP outreach work. CHA's SMP staff encourages other advocates working with Spanish-speaking beneficiaries, particularly those with low-incomes, to help spread the information on these tactics. To keep the message simple, let beneficiaries know that should one or more of the following happen to them, they should be suspicious and call their local HICAP.

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