Fraud and its impact on Seniors in South Florida

By: Lupe Bruneman

Para leer en Español

Regrettably, Fraud is a big and negatively impactful reality for too many South Florida seniors and it has many faces. One of the most common form of fraud is that seniors are enrolled in Medicare Advantage plans without their consent.  They don’t understand what they are signing, and often times are also enrolled by phone via call centers who target seniors for the sole purpose of enrolling them into plans, without conducting proper needs assessments.  Another common form of fraud comes by way of unscrupulous insurance sales agents, who either from ignorance or financial need, will enroll a senior in a Medicare plan, and not assist the enrollee in understanding its benefits, costs, and nuances of access to their preferred providers and medical facilities. 

Medicare Advantage fraud in South Florida is significantly higher than the national average—driven in part by aggressive and targeted scams against seniors. This fraud could represent billions of dollars, with South Florida constituting a major hotspot. Seniors in the region are at particularly high risk and should be especially vigilant.

One way you can guard yourself against Medicare fraud is to adhere to the following guidelines:

1. If you are being offered cash for ANY medical services, this is fraudulent in EVERY case and you should not accept it;
2. If you speak to a licensed insurance agent and they only offer you 1 insurance plan option, ask them why they are not showing you a comparison?;
3. Ask about the cost and coverage of your medications;
4. Ask whether you can continue seeing any physicians or medical facilities you don’t want to lose;
5. Ask the agent if they represent more than 1 company;
6. Ask the agent how many years they have been in the healthcare industry;
7. If you already have Medicare coverage and you are happy with it, and someone calls you, respectfully decline to speak and ask to be removed from their call list and hang up;
8. If you visit a Medical Center and they ask you to sign papers, DON’T SIGN THEM. Express you will take the papers home and review them and come back if you decide to move forward;
9. Speak with anyone you trust to help you make this decision because making the wrong decision for your health insurance coverage could seriously hurt your health in the future when you get sick and you need it most.
10. Medicare, nor Social Security make outbound calls, so if anyone calls you saying they are calling you from either of these federal agencies, HANG UP. They are lying to you.

                  Medicare Advantage is considered supplemental coverage to what’s called “Original Medicare” which is Federal health insurance provided to people 65 and older who qualify for the program.  Medicare Advantage has many synonymous terms, such as MAPD, HMO, PPO, etc., and there any MANY options available.  These options change by COUNTY and you should do your homework or reach out to a respected and trusted source to assist you.   If you are older than 65, and are in need of Medicare coverage, you can contact us at Advocate Health Advisors at (786) 322-8633.  We will assist you in reviewing all the available options in your area, without cost or obligation.  If you feel you have been a victim of Medicare Fraud, please report it to them directly at 1-800-633-4227.