#USA #Oakland #Blue Shield #Medicare Scam #Health Fraud

Blue Shield of California Urges Seniors to Stay Vigilant Against Medicare Scams

In line with Medicare Fraud Prevention Week, Blue Shield of California is raising awareness about the increasing prevalence of Medicare scams and the importance of protecting older adults. As healthcare fraud becomes more widespread, safeguarding the elderly has never been more critical. The nonprofit health plan's outreach highlights various scams, including fraudulent medical supplies, services not received, and suspicious charges, all targeting Medicare beneficiaries.

In 2024, the U.S. Department of Justice filed charges against 193 individuals, including 76 healthcare professionals, in a nationwide operation aimed at curbing Medicare fraud, with fraudulent claims surpassing $2.75 billion, covering telemedicine services and falsified prescriptions.

Alex Uhm, the Vice President and General Manager of Blue Shield, stated, "Fraud and scams targeting Medicare represent a significant threat to seniors." He emphasized the organization’s commitment to enhancing preventive measures and educating members about protecting themselves against fraudulent activities.

As part of Blue Shield's initiative, the organization is distributing informational materials that detail common fraud tactics and preventive measures while providing an online portal for members to report suspected fraud conveniently. The Special Investigations Unit (SIU) at Blue Shield is dedicated to identifying healthcare scams and ensuring member safety by detecting suspicious activities that may indicate fraudulent behavior.

The SIU team collaborates to tackle fraud in various sectors, focusing on a few usual scams targeting seniors, including:

• - Unsolicited Medical Supplies: Seniors receiving items like catheters or diabetic supplies that they did not order or need.
• - Identity Theft: Scammers impersonating health plan representatives to obtain personal information.
• - Phantom Billing: Charges for services or tests that were never conducted.
• - AI-Driven Fraud: Emerging tactics use beneficiary data to bill for unrequested services, employing artificial intelligence to impersonate members and providers or to fabricate medical histories for billing purposes.

To aid in fraud prevention, Blue Shield encourages its members to:

• - Scrutinize Benefit Summaries: Carefully review Explanation of Benefits (EOB) documents for any discrepancies.
• - Safeguard Personal Information: Avoid sharing personal data over the phone or online unless the identity of the recipient is verified.
• - Report Suspicious Activities: Immediately report any unknown charges or unreceived services to the SIU. Seniors or their caregivers who suspect fraud can contact Blue Shield's Medicare fraud hotline at (855) 331-4894 (TTY711) or email [email protected].

Medicare beneficiaries are also advised to take the following steps if they suspect fraud:

• - Contact Their Health Plan: Use the number provided on health plan cards to report suspicious activities.
• - Report Lost or Stolen ID Cards: Immediately inform the health plan of any lost or stolen ID cards and request a replacement.
• - Monitor EOB: Examine EOB carefully for unfamiliar services.
• - Beware of Unknown Calls: Even if caller ID appears legitimate, do not confirm personal information over the phone.
• - Protect Health Cards: Do not lend health plan cards to anyone.

For more tips on protecting against healthcare fraud, visit Blue Shield's Fraud Prevention page.

Founded in 1939 in San Francisco and headquartered in Oakland, Blue Shield of California is committed to creating a healthcare system that is not only worthy of family and friends but also sustainably affordable. The nonprofit health plan, which has a non-exempt tax status, operates independently under the Blue Shield Association, serving approximately six million members with over 7,500 employees and annual revenues exceeding $25 billion. Over the last three years, the company has contributed more than $60 million to the Blue Shield of California Foundation for the benefit of California communities.

For further news on Blue Shield of California, please visit their Spanish news center at es.news.blueshieldca.com/ or follow them on LinkedIn or Facebook.