Beware Medicare fraud risk

However, this creates a major conflict of interest for agents who sell these plans on behalf of the companies, Lipschutz says.

"The new monetary incentives to maximize enrollment were the matches that started the fire of marketing misconduct," says Lipschutz. "They were tremendous incentives for agents to steer people toward plans that would only benefit the agents."

Kuchler says the "overwhelming majority" of companies and agents are ethical and lawful when marketing their plans.

But Lipschutz and others say some agents are less ethical. Unscrupulous agents use several tactics to sell their policies, they say. Although Medicare never contacts its beneficiaries by phone, some agents indentify themselves as Medicare representatives when cold calling seniors at home.

"That's a common tactic," Holland says.

Dual-coverage targets

Paul Precht, director of policy and communications for the Medicare Rights Center in Washington, D.C., says low-income seniors who have both Medicare and Medicaid are particularly vulnerable to unscrupulous health insurance agents.

Seniors with dual coverage are able to change their plans once every month because they often have more chronic health conditions than patients covered only by Medicare, Precht says. Waiting months for the next enrollment period to change plans could be problematic for these seniors.

Some insurance agents see these dual-coverage seniors as prospects to boost enrollment and profits during the "off-season" from the annual open enrollment period.

Enticed by freebies such as cell phones or eyeglasses, seniors are assured by hard-selling agents that their benefits will remain the same or improve, and that their physician is included in the private plans' network.

After they enroll, however, seniors often find they were swayed by empty promises. In the worst cases, they are caught without coverage and stuck with paying medical costs out of pocket.

Kuchler acknowledges that consumers who consider enrolling in Medicare Advantage need to do their homework first.

"Along with (increased) choice comes the need to do one's research to pick a plan that best meets your situation in terms of health needs and finances," he says.

Staying safe

Fortunately, there are many other things seniors can do to avoid becoming a victim of Medicare fraud.

Vigilance is the best protection against fraud. Lipschutz advises seniors to protect themselves by keeping a healthy skepticism toward any health insurance agent.

"Never feel pressured, and do your homework by assessing the coverage you have," he says.


He also recommends double-checking every claim made in a sales pitch.

"Trust, but verify," he says. "Well, maybe not trust."

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