How to Keep Clients Safe from Insurance Fraud

When your clients are applying for healthcare coverage, the last thing you want is for them to fall victim to fraudulent sales practices.

Scams are year-round but can be particularly harsh during the Annual Enrollment Period (AEP). That’s why it’s always a great time to help your clients protect themselves and learn how to identify potential threats.

Unsolicited Calls from “Medicare Representatives”

Clients need to be wary of anyone calling and claiming to be a Medicare representative. It is against the Centers for Medicare & Medicaid Services (CMS) rules to cold call, and they should hang up immediately.

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It is against CMS rules to cold call, and they should hang up immediately.

Some scammers can even tamper with a caller ID and make it look like the number is coming from a Medicare office. To be safe, your clients should never give any of their information over the phone. It’s best to tell them to wait until they have a meeting with you, their current insurance agent.

Use of Superlatives or Time Restraints

CMS will never endorse a plan, which means a client should never hear that there is a “best” plan option they need to choose. While they should be enrolling in a plan that best fits their needs, hearing a superlative when referring to a plan should be an immediate red flag.

Every Medicare-eligible beneficiary has from October 15 until December 7 to make an enrollment decision. Advise clients that anyone who makes them feel pressured to enroll in a plan right away is most likely a scammer.

For example, someone might call a Medicare beneficiary and tell them they must enroll in a plan by noon that day, so they won’t have a lapse in their coverage.

Private Insurance Scams

Clients can also fall victim to scams from private insurance companies selling Medicare Advantage plans. Sometimes these scammers will sell your client a plan that isn’t available in their county, leaving them with more out-of-pocket expenses but no coverage.

Encourage clients to ask you questions about plan options and the enrollment process before they decide to make a purchase.

A great way to avoid this is for your clients to be educated. Encourage them to ask you questions about plan options and the enrollment process before they decide to make a purchase.

Medicare Genetic DNA Testing Fraud

If you get an email proposing you can make big bucks from taking a couple of DNA swabs from Medicare beneficiaries, is it too good to be true? Chances are that it is!

The Centers for Medicare & Medicaid Services (CMS) approved Medicare coverage of certain beneficiary genetic testing. However, you need to be aware that fraudulent behavior, due to solicitation and improper billing, has been identified involving these tests.

What Clients Should Know About Genetic Testing

Clients should always confirm that their test has been ordered by their doctor, that it’s covered by their plan, and that it’s medically necessary. Also, beneficiaries should never give out their Social Security, Medicare/health plan numbers or banking information to someone they do not know.

Your clients should also never consent to any lab tests without their doctors’ orders.

Your clients should also never consent to any lab tests without their doctors’ orders. Please advise your clients to call the customer service number on the back of their ID cards to discuss coverage or other concerns.

As an agent, be wary of any entity offering payment for referrals of medical services paid for by Medicare. Promotions involving compensation for facilitating genetic testing are prohibited, and participation could violate compliance regulations. If something sounds too good to be true, it most likely is.

Be Aware of Insurance Scam Tactics

The best thing you can do to help your clients avoid insurance scams is to stay educated with current scams. Sadly, there’s always news circulating about the latest medical and insurance scam attempts and schemes.

If you become aware of a scam tactic and think your clients could be at risk, send out emails, or make follow-up calls to give them a heads up. As an insurance agent, your job is to look out for the best interests of your clients, even after sales are closed.

Tips for Health Insurance Scam Prevention

Here are some simple tips to give clients to help keep them from getting caught in a scary health insurance scam.

1. Protect Medicare and Social Security information

All personal information should be protected, especially Medicare and Social Security information. Tell clients to never give out their Medicare or Social Security number or information to anyone they don’t have a prior professional relationship with, especially over the phone, through text, or email.

Encourage clients to review their Medicare Explanation of Benefits (EOBs) and report any services they didn’t receive.

2. Be Wary of Who Is Calling, Texting, or Emailing and Why

With artificial intelligence on the rise, voice cloning and deep-fake impersonations are becoming more common scams. Remind clients to reach out to who is calling on a known number they’ve used in the past and to never give away personal information to anyone calling.

Medicare will never call a beneficiary asking for personal information.

Medicare will never contact a beneficiary uninvited and request personal information. Scammers often impersonate officials to “activate” accounts or threaten coverage cancellation.

Instruct clients to disengage, stay calm, and report suspicious contact immediately.

3. “Free” Always Comes with a Catch

Even something as small as a pill organizer can cost more than expected if personal information is exchanged. Free isn’t truly free when data is involved. Advise clients to decline offers that require personal information no matter how harmless they seem.

Final Thoughts on Avoiding Scammers

Scammers are always going to prey on the vulnerable, so the insurance world can be tough to navigate for many beneficiaries. Even the most savvy consumer could fall victim. Here are some final reminders to help your clients avoid common scams:

• Keep personal information private
• Never accept gifts or freebies “paid for by Medicare”
• Ignore pressure to enroll in any plan
• Report potential scams right away to 1-800-MEDICARE

It’s important you do your part to educate clients on these scam tactics. Make sure they know that you are their point of contact regarding their plan(s) and insurance questions. You have their best interest at heart and the power to keep clients safe and satisfied with their health coverage!

As your FMO, we can help you watch out for scams and fraud happening within the industry, give you the tools necessary to keep in touch with your clients, and grow your business. Register with RitterIM.com for free today, and we’ll all do our part to keep those around us insurance scam- and fraud-free!