The Impact of Medicare Fraud

According to the Medicare Trustees report in 2012, the total Medicare expenditure was $574.2 Billion. Today’s prediction of overall Medicare expenses for 2022 has nearly doubled, at $1.0877 Billion. This dramatic projected increase is due in part to a significant growth in the number of people eligible for Medicare—aging Baby Boomers—and inflation. With legitimate Medicare costs expected to rise, reducing loss due to fraud, errors, and abuse is even more vital.

The Economic Impact

The economic impact of Medicare fraud, errors, and abuse on taxpayers, and the solvency of the Medicare Trust Fund are the most frequently touted reasons for addressing this problem. Less often discussed, are the financial and mental health impacts to individual Medicare beneficiaries who are victimized.

Fraud is intentional, and the types of fraud schemes are complex, and sometimes even include organized crime involvement. Scam artists target Medicare Beneficiaries to obtain sensitive personal identifying information, such as Medicare, social security and bank account numbers. The most prevalent scam consists of individuals contacting beneficiaries, claiming to represent Medicare and saying the beneficiary needs a new Medicare card. Beneficiaries are then asked to provide their personal sensitive information. In this way, it is estimated that $60 Billion is lost each year nationwide to Medicare Fraud.

Furthermore, the personal impact to Medicare beneficiary’s finances can also be devastating:

• Beneficiaries may be billed for unnecessary equipment or services not covered by Medicare
• Beneficiaries may be scammed out of their savings when scammers gain access to Social Security or bank account numbers
• Beneficiaries may be responsible for paying for future services that were fraudulently billed to Medicare in the past

Mental Health Implications

The financial loss that is experienced by Medicare beneficiaries is especially insidious when considering that seniors also experience grief accompanying their financial loss. Research published by the National Institute of Health demonstrates that bereavement—grief or loss—is disproportionately experienced by older adults.

In addition, according to the National Council on Aging, approximately 80% of older adults live with a chronic disease, such as arthritis, diabetes, and high blood pressure. These physical health issues can also contribute to mental health stress. Not to mention, physical health issues can mean the inability to use coping mechanisms like reading, physical activity, and socializing. Exacerbated by the pandemic, seniors are especially susceptible to isolation, leading to loneliness and longing for social connections that contribute to mental health and vulnerability against scam calls.

So, how can one cope with financial loss?

• Contact SHIIP/ SMP for assistance
• Report your experience to 1-800-Medicare and the Federal Trade Commission.
• Consider seeking professional mental health support. A mental health professional can help you learn ways to cope with loss.
• Tell others. By sharing your story, you can educate your friends and family and actively work to help us fight fraud.

For more ways to prevent, detect, and report suspected Medicare fraud, errors, and abuse, visit shiip.iowa.gov.