Are you receiving all your Medicare benefits?


Scam asks if you’re receiving your entitled beneifts

The Fraud Alert - Don Shrader



As I was preparing to write this month’s fraud alert, I received a phone call. The voice on the other end claimed to be from some sort of Medicare Assistance agency. She further claimed that the purpose of their call was to help me be certain that I was getting all of the Medicare benefits to which I was entitled. I decided to play along to be certain that I had the “scam” process correctly diagrammed.

The caller’s first item was to confirm that the person to whom they were speaking was I. After that, the young lady on the other end confirmed that I was receiving Medicare Parts A and B. Then she asked if I also had a Medicare supplemental plan. I told her that I did. At this point, she stated that she wanted to be certain that I was receiving all of the Medicare benefits to which I was entitled and asked if it would be OK to transfer me to another agent. I said “yes,” which is the “gotcha” as I will explain later.

The next person reconfirmed my name and the fact that I was currently receiving both Medicare parts A & B. Then, to be certain that he directed my call to the proper agent, he asked for the zip code where I was living. I gave him my zip code, at which time he transferred my call to a “licensed insurance agent.”

On previous solicitations like this, when they wanted to transfer me to a licensed agent, I asked what their licensed agent was going to provide me that the current licensed agent I use each year was unable to provide. The only response I got was that they just wanted to be certain that I was getting all of the benefits to which I was entitled.

To play along with one of these earlier calls, I agreed to talk to a licensed agent. She asked me a bunch of questions and then recommended a different insurance company, obviously one that pays her a commission. When I asked how I could change insurers since it was beyond the deadline to switch, she stated that Ohio had a special provision that year to allow people to switch supplemental insurers even though it was past the deadline. Again, to play along, I gave her the name of my general physician. Guess what! He was not listed as one of that insurer’s “in-network providers.” Gee, I wonder why? The agent on the phone told me, however, that they could provide me with a list of good in-network physicians to whom I could switch.

To be fair, the agent I have used every year since I first became eligible for Medicare did look at the insurer the agent on the phone was recommending. However, my agent recommended a different insurer, with whom I am very happy, for a variety of reasons that he provided to me, including the fact that my current physician was not in-network

I then asked the agent on the phone, how she circumvented the Medicare law that prohibits direct solicitation of the public. Surprisingly, she confessed that when talking to the person that did call me who then asked if it would be OK to switch me to another agent and I answered, “yes,” I had in essence given my permission to talk to a licensed agent.

This reminds me of the old long-distance telephone scam wherein one of the many, at that time, long-distance phone providers would call to offer a lower rate – supposedly. Even if it was not a lower rate, or you simply did not want their service, if you ever said “yes” during the call, they would most often switch your service to their company. After all, you said, “yes.”

I don’t know the commission rates paid by insurance companies to be “represented” by licensed insurance agents, but it evidently is sufficient for former NFL quarterback Joe Namath to be on almost every TV station every few minutes for months before and after the official enrollment period. However, in that case, when you call the toll-free number, you have initiated the call and it is not a direct solicitation. The commission rate is also, evidently, sufficient for three licensed agents to set up a nice office in Dayton just to service eligible Medicare recipients. And, finally, it is sufficient for John Q. Public often to receive telephone solicitations like those I described above.

While those participating in a direct call to you may think the “scam” I described above is not truly illegal because of the circuitous route they have used to circumvent the rules, according to a reliable source of mine, it is totally illegal. According to my source, “Licensed, Certified, and Authorized Agents are not permitted to make unsolicited telephone calls to Medicare Beneficiaries for the purpose of selling Medicare Plans. Additionally, agents are not permitted to hire (or otherwise use the services of) anyone else to make that unsolicited telephone call on their behalf. Nor are Agents permitted to use “leads” that were obtained via unsolicited telephone calls/contact. Also, Agents are not permitted to make any type of personal unsolicited contact such as knocking on doors, hanging fliers on doorknobs or placing them on cars, and/or approaching individuals in public settings,”

Generally, such calls are not a threat directly to your bank or credit card accounts even if they are possibly a threat to actually receiving the best supplemental Medicare benefits for you. Do NOT ever agree to pay directly for such assistance! Also, never provide any personal information to anonymous callers such as a credit card numbers or your Medicare or Social Security numbers! It is always a possibility that the caller is looking to obtain such personal information for felonious and fraudulent reasons. Remember, the crooks are always very smooth and very bold.

Regarding your initial and annual Medicare enrollment, my recommendation is that you find a good licensed agent whom you know and can trust that specializes in working with Medicare and is dedicated to working with you for the long term and not just interested in a quick sale. Then, during each annual enrollment period, work with that agent to obtain the best plan for you, and hang up on these other fraudulent phone calls. My Medicare insurance specialist notes the following: It is estimated that the average couple can expect to incur approximately $300,000 in medical expenses from age 65 to age 80 (not including long-term care). This is a sizable sum that should be treated with the respect it deserves. Medicare health insurance is a financial asset, and as such, one should choose his Medicare agent just as one would choose his physicians, attorneys, or financial advisors.

Also remember, if you are enticed by a TV ad or the like to call the 800-number provided, the salesperson’s job is to sell you something during that telephone exchange. The salesperson who answers the phone is working on their insurance company’s behalf, not yours.

Another qualified source at Senior Medicare Patrol noted the following: If someone is interested in getting a better understanding of the Medicare plans that are available to them and what is best for their needs, we suggest they contact the Ohio Senior Health Insurance Information Program, OSHIIP. They are part of Ohio Department of Insurance, and do not sell anything and they do not choose a plan for a beneficiary. They help the beneficiary understand the plans that are available to them in their area. OSHIIP can be contacted at 800-656-1578.

Scam asks if you’re receiving your entitled beneifts

The Fraud Alert

Don Shrader