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News March 2016

Dollar Sense

Are You Smarter Than a Medicare Thief?

By Teresa Ambord

Have you seen TV ads offering free tests and free medical equipment such as a free brace, for your neck, back, or knee, syringes, or other items?  If you respond, you may or may not receive what is promised. Even if you are given free tests, there’s no guarantee that your tests will be processed.  It doesn’t matter to thieves because they’ve what they want: your Medicare number.

Assuming you’re not a thief, then you obviously are smarter.  Still, crooks can be pretty convincing, pulling the wool over the eyes of otherwise intelligent people.  If they can fool you into providing your Medicare ID (or other insurance ID), the payoff can be enormous for them.

Here’s an example of what one real life criminal pulled off:

In January 2016 the owner of three Los Angeles clinics was sentenced to prison and a hefty financial penalty for submitting $4.5 million in fraudulent claims to Medicare.  His crimes? Hovik Simitian  paid cash kickbacks to patient recruiters who were sent out to bring Medicare patients into the clinics.  He and his staff then billed Medicare for lab tests and other services which, he now admits, were not medically necessary or in some cases, were not even provided to the patients who’d given him their Medicare numbers. 

After his crimes were exposed, Simitian admitted falsifying documentation for more than $4.5 million in false and fraudulent Medicare claims. He received nearly $1.7 million of those claims. He’s now sentenced to pay back that $1.7 million in restitution, plus 6.5 years in prison.

The investigation was conducted by the Medicare Fraud Strike Force, which currently operates in nine cities across the country. Since its inception in March 2007, over 2,300 defendants have collectively billed Medicare for over $7 billion in fake claims.  Simitian’s crime represents just one form of Medicare fraud: setting up fake clinics.  (You can read about more convictions at But there are many other forms.


‘Free Back Brace’

Have you seen TV ads offering free tests and free medical equipment such as a free brace, for your neck, back, or knee, syringes, or other items?  If you respond, you may or may not receive what is promised. Even if you are given free tests, there’s no guarantee that your tests will be processed.  It doesn’t matter to thieves because they’ve what they want: your Medicare number.


Fake Medicare Calls

Another scam might take the form of a phone call from someone claiming to be from Medicare. Your caller ID may even say the call is from Medicare, but that’s all part of the scam. The caller may sound professional and friendly, and inform you:

  • You are entitled to additional benefits which will be deposited into your bank account. 
  • Or, you are being issued a new Medicare card or prescription card.
  • Or perhaps that there is a problem with a recent billing to your Medicare account and if it’s not cleared up, you’ll have to pay charges yourself.
  • You may even be told that if you don’t provide your full Medicare number, your benefits may be discontinued.

There is almost always a sense of urgency, as in, a warning that if you don’t act immediately there could be dire consequences or you could at least lose a great opportunity.  The caller may insist that you “verify” your Medicare number or private insurance number, (and perhaps your bank account number). He or she may already know part of your Social Security number, and will tell you those digits as a way to establish their legitimacy in your mind.

The Federal Trade Commission has fielded many complaints for just this sort of scam, so don’t fall for it. They warn, never give out your Medicare ID, your Social Security, or your bank account number to a caller.  In fact, don’t even affirm that you are a Medicare recipient. “Simply hang up the phone,” advises the FTC.

What if you think the call might be real?  Reassure yourself by calling yourself, at 1-800-MEDICARE.  Explain the situation and ask if someone is trying to reach you. 

If you think it’s a scam, report the incident to the FTC at 1-877-FTC-HELP or go online to Click on “Scams and Rip-offs” and then “Imposter Scams.”

You can also report your suspicions to:

Office of Inspector General
Call: 800-447-8477
TTY: 800-377-4950 
Online: Report Fraud


Centers for Medicare and Medicaid
Call: 800-633-4227 / TTY 877-486-2048
Resources galore and mugshots

The StopMedicarefraud site listed above has an abundance of information you may find interesting, like warning signs of fraud and how to respond. There’s even a page of mugshots you might find interesting, of the most-wanted fugitives related to health care fraud and abuse. You’ll find it here:


Medical Identity Theft

It’s not always a clinic or a free offer on TV that results in the theft of your Medicare number. Anyone who uses your name or Medicare number (even with your permission) to file claims, or obtain prescription drug is committing medical identity theft.  How does this kind of theft happen?

  • Sometimes it happens when an unscrupulous employee at your doctor’s office steals your number to use it or sell it. 
  • Your insurer could be hacked and thousands of patient records compromised.
  • Or someone in your home — a housekeeper or gardener, or even a family member or friend who isn’t really trustworthy — might see your Medicare card if you don’t carefully guard it – and copy your number or even steal your card. 
  • Occasionally a well-meaning Medicare recipient allows another person who has no insurance to use an insurance number to obtain medical care. If you do that, your heart may be in the right place, but it’s still fraud and you could find yourself in hot water.  However this happens, when someone else uses your Medicare card, his or her health information gets combined with yours.  And your future health care, insurance, payment records, and credit report may suffer. Contact Medicare or Medicaid to report the problem and receive direction. Call: 800-633-4227 / TTY 877-486-2048 or go online to:


Volunteer Opportunities are Available to be a Medicare Fraud Fighter

If you have extra time and want to help reduce Medicare fraud, consider becoming a Senior Medicare Patrol (SMP) volunteer. These highly trained SMP volunteers teach others about health care fraud. They show Medicare and Medicaid recipients how to protect, detect, and report fraud. Their efforts help protect citizens’ health, health benefits, and strengthen Medicare and Medicaid.

Think you don’t qualify to be an SMP volunteer? Some SMP volunteers are professionals such as doctors, nurses, accountants, law enforcement, attorneys, teachers, and others. But many are also seniors who have some time and who care about protecting Medicare for themselves, for others, and for the future.

What does a volunteer do?  You might help other people with tasks such as reading Medicare Summary notices, protecting their identities, and showing them how to avoid falling for scams. It might involve working one-on-one with other Medicare recipients, or presenting to small groups, or attending events as a representative. It depends on what you are comfortable with.  If you live in a senior community, you might want to host a get-together and share your newfound knowledge with neighbors.

You can learn more about becoming a volunteer fraud fighter by logging onto  to find an office near you.  I did, and had a call back within one day.

And speaking of thievery, do you know where we say of a thief he’ll “rob you blind” or “steal you blind? Experts at the Chapman Dictionary of American Slang report this saying has been common since the mid-20th century. They name two possible original meanings:

  1. Everything you have is being stolen including your sight, or
  2. You’re so easy to rob, you may as well be blind.

The bottom line is, Medicare’s future is in jeopardy and it seems unlikely that Washington D.C. is going to help.  But we can each help ourselves by not being so easy to rob that we “may as well be blind.” Don’t let Medicare thieves pick your pockets.


Teresa Ambord is a former accountant and Enrolled Agent with the IRS. Now she writes full time from her home, mostly for business, and about family when the inspiration strikes.

Meet Teresa