Medicare Has a Tele-Scam Problem

Medicare Has a Tele-Scam Problem

Telephone scammers are bilking Medicare out of billions of dollars, and bombarding millions of older U.S. consumers with multiple daily automated phone calls for everything from “free” back braces to genetic tests.  While Medicare scams have been with us for decades, what’s new is the use of automated calling technology, and the massive international scale of the scams.

In September, federal agents announced the arrests of 35 people linked to a huge genetic testing scam.  Individuals charged are accused of billing Medicare for more than $2.1 billion worth of phony genetic tests.  The crackdown included telemedicine companies, doctors, and labs which worked in an elaborate scheme that preyed on people’s fears of having genetic markers for cancer.

Genetic testing is not routinely used by doctors to screen for cancer.  Here’s how the scam works— The “target” (that’s anyone close to age 65 and up) might receive automated phone calls, often multiple times a week, or may be approached in-person by a “recruiter.” The recruiter, who may present herself as a “certified Medicare counselor,” convinces the target to take a genetic test promising that Medicare pays the full cost.  The patient, however, often never receives a report, or the report may be incomprehensible.

The fraudsters enlist unscrupulous doctors to approve the test and the doctor receives a kick back from the recruiting company for each prescription.  Medicare receives a bill that can range from $7,000 to $19,000.  Victims have later reported that they did not even know the doctor who prescribed the test.  Law officials warn that health fairs, senior centers and even church events are magnets for the scam, where recruiters take cheek swabs for genetic testing and collect Medicare numbers.

Not only does this put unwitting retirees’ Medicare number in the hands of crooks who can then resell it to be used to file more false claims, but it can cause Medicare to deny future coverage for genetic testing when it’s really needed, because the patient’s record will show the test has already been performed.

According to Medicare, no single organization was behind the 35 people charged in the genetic testing scam, which included 9 doctors.  All of this comes at a time when Medicare and Medicare Advantage are expanding the use of telemedicine, which allows doctors and nurses to connect with patients over the internet or by cell phone for consultations and to check symptoms remotely.

Editor’s note:  Telephone etiquette has changed!  Ask around, and you’ll probably discover that many people are letting their voice mail or answering systems screen calls.  This is no longer considered rude — but acting in self - defense.  Protect yourself from scam (and your dinner from getting cold due to calls at meal time.).  Be defensive:

  • Screen your calls:  Even if you have caller ID, experts suggest screening calls any way.  More robo-callers are making their calls appear to be local by using phone numbers from your own local calling area.  Unless you know the number of the caller is legit, don’t pick up.  Legitimate callers, such as your doctor’s office calling to remind of an appointment, will leave a message.  Tell your family and friends to leave a message and to keep talking at least long enough for you to get to the phone if your phone’s speaker allows you to hear the caller’s message.
  • Use call block technology.  If you have a smart phone, you can block calls from unknown numbers.  Some land line phones also have similar technology.


Sources:  “Phone Scammers and ‘Tele-doctors’ Charged With Preying On Seniors in Fraud Case,” Victoria Knight, NPR Health News, October 7, 2019.  “U.S. Thwarts Medicare Genetic Testing Scam,” Associated Press, September 29, 2019.