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SALT LAKE CITY — Senior Medicare Patrol, a volunteer-based organization that finds and reports health care fraud, is advising Medicare beneficiaries to read their Medicare summary notices and keep an eye out for allergy tests they never requested nor received.
These fake allergy tests are typically tacked onto any kind of diagnostic test but have been especially prevalent with COVID-19 tests.
Add-ons are not unique to Medicare users, according to Senior Medicare Patrol fraud consultant Jennifer Trussell. They can happen to anyone who receives any kind of health care. But older adults can be more susceptible to the fraud.
"The SMP continually sees complaints from individuals who have billings on their Medicare statement for services that they did not receive," Trussell said.
Why are allergy test add-ons a problem?
The immediate problem with add-on allergy tests is that they cost money. If the insurance company doesn't cover the tests added on, the patient will likely be charged. In 2019, Senior Medicare Patrol saved Medicare and Medicaid beneficiaries $602,063 by uncovering fraudsters.
The less obvious problem — but perhaps more serious — is that add-on allergy tests are often a sign that a patient's medical identity has been stolen. If there is a test you did not receive on your insurance statement, you could end up paying for someone else receiving health care under your name.
Identity theft can also damage a person's credit and interfere with someone's medical treatment.
How do allergy test add-ons happen?
This type of fraud often occurs through unsolicited phone calls, according to Trussell. Fraudsters will make calls under the guise of Medicare representatives, then trick beneficiaries into giving them their Social Security number, Medicare number or other personal information. They can then use that information to bill Medicare for fraudulent tests.
Mary Jo Hanson, a resident at the Roy Hillside Senior Center, remembers receiving a call like this.
"They sounded really official," she said.
After the caller verified her name, date of birth and address, which they already knew, they started asking for more personal information. Hanson started to feel suspicious when the caller became more pushy — as Trussell says they often are — and hung up before they could get her Social Security number.
Hanson reported the caller's phone number to the senior center but is unaware if the fraudster has done anything with her Medicare number, which she did give them. She says calls like that have made her hesitant to pick up phone calls and click on emails from her friends and family.
How can you avoid allergy test add-ons?
Trussell urges Medicare beneficiaries to always be cautious when answering unsolicited calls, especially if they weren't expecting a call from Medicare. If you suspect a caller to be fraudulent, she says, ask for their number so you can call them back to verify who they are.
It's rare for patients to fall victim to add-ons when they visit their regular health care provider or a widely known drugstore, like CVS or Walgreens. The problem arises when they get their diagnostic testing done off the beaten path.
"I can't tell you how many people would see an ad on Facebook about free COVID testing in a parking lot at a strip mall on a Saturday, and they would go," Trussell said. "Those were often fraudsters."
If you have to receive services from a lesser-known health care provider, do your research to make sure it's legitimate.
What should you do if your Medicare statement has an allergy test add-on?
If you notice any unfamiliar allergy tests on a Medicare summary notice, Senior Medicare Patrol first recommends calling your provider or plan to ask for an explanation.
If they aren't able to explain the tests, report them to your local Senior Medicare Patrol project, which will help determine if there is fraud and refer your case to the appropriate agency for further investigation. In 2021, Senior Medicare Patrol contributed to $2.5 million in Medicare recoveries.
Insurance fraud can also be reported directly to the insurance company or to local law enforcement.
What other forms of health insurance fraud should you look out for?
Allergy test add-ons are just one of the many types of health insurance fraud, all of which suggest identity theft.
The recent pandemic unleashed a slew of scams associated with COVID-19. Free at-home COVID-19 tests have been showing up on the doorsteps of people who never asked for or wanted them — which Trussell says warrants a call to Senior Medicare Patrol.
Genetic testing scams are also a common source of health insurance fraud. Representatives of fraudulent companies will go to senior centers, health fairs and even parking lots to offer people free genetic testing — also called "DNA screenings," "cancer screenings" and "hereditary testing."
These kinds of scams are especially costly — over half of Medicare recoveries reported by Senior Medicare Patrol in 2021 came from a single genetic testing scheme, for which the company involved was made to pay $1.4 million.
Fraud associated with durable medical equipment, like braces or diabetic supplies, is also prominent right now, according to Trussell. Medicare beneficiaries should be wary of claims for equipment on their Medicare statements, equipment showing up at their homes and sales people offering them "free" equipment in exchange for their private information.
To contact Senior Medicare Patrol, visit smpresource.org/.
