Blue Shield of California Helps Seniors Be on Alert for Medicare Scams

Nonprofit health plan urges members and the public to protect themselves from fraud involving medical supplies, services not received, and suspicious charges

, /PRNewswire/ -- In observance of Medicare Fraud Prevention Week, Blue Shield of California is highlighting its commitment to safeguarding Medicare beneficiaries against scams and fraudulent activities. With healthcare fraud continuing to rise across the country, protecting seniors has never been more critical.

Highlighting the severity of Medicare fraud, the U.S. Department of Justice charged 193 individuals, including 76 medical professionals, in a nationwide healthcare fraud enforcement action in 2024. The schemes involved over $2.75 billion in alleged false claims, including fraudulent telemedicine and prescription drug schemes.

"Medicare fraud and scams continue to pose a serious threat to older adults," said Alex Uhm, vice president and general manager at Blue Shield. "We are committed to enhancing our preventive measures and providing our members with the tools and knowledge to protect themselves."

Blue Shield's efforts to protect its members include distributing updated member education materials that highlight common fraud schemes and preventive measures, and the introduction of an online portal for members to report suspected fraud.

Blue Shield's Special Investigations Unit (SIU) is dedicated to detecting healthcare fraud and protecting our members by identifying suspicious activity and potential fraud. This proactive approach helps keep members safe and ensures fraud is addressed quickly.

Blue Shield's SIU team tackles fraud across all areas, but experts have identified several prevalent scams targeting seniors, including:

• Unsolicited medical supplies: Receiving items such as catheters, diabetic supplies or back braces that were neither ordered nor needed.
• Impersonation scams: Fraudsters posing as health plan representatives to obtain personal information.
• Phantom billing: Charges for services or tests that were never provided.
• Artificial Intelligence (AI)-driven fraud: Emerging tactics include the misuse of beneficiary information to bill for unrequested services, and the use of AI to impersonate members and providers, as well as fabricate medical records for billing purposes.

Blue Shield encourages its members to:

• • Review statements: Carefully examine Explanation of Benefits (EOB) statements for any discrepancies.
  • Protect personal information: Avoid sharing personal details over the phone or online unless certain of the recipient's identity.
  • Report suspicious activity: Immediately report any unfamiliar charges or services not received to the health plan's Special Investigations Unit (SIU). If seniors or their caregivers suspect fraud, call Blue Shield's Medicare fraud hotline at (855) 331-4894 (TTY:711) or email [email protected].

Medicare beneficiaries who suspect fraud or scams are also encouraged to take these actions:

• Contact your health plan: Use the phone number on your health plan card to report any suspicious activity.
• Report lost or stolen ID cards: Inform your health plan immediately if your ID card is lost or stolen, and request a new card and ID number.
• Review your statements: Carefully examine your Explanation of Benefits (EOB) for any services you do not recognize.
• Be cautious with phone calls: Even if the caller ID looks legitimate, do not confirm any personal information such as your Medicare number or social security number over the phone.
• Protect your health plan card: Never loan your health plan card to anyone.

For more tips on how to stay safe from healthcare fraud, visit:
https://www.blueshieldca.com/en/home/about-blue-shield/preventing-fraud 

About Blue Shield of California
Blue Shield of California strives to create a healthcare system worthy of its family and friends that is sustainably affordable. The health plan is a tax paying, nonprofit, independent member of the Blue Shield Association with nearly 6 million members, over 7,500 employees and more than $25 billion in annual revenue. Founded in 1939 in San Francisco and now headquartered in Oakland, Blue Shield of California and its affiliates provide health, dental, vision, Medicaid and Medicare healthcare service plans in California. The company has contributed more than $60 million to Blue Shield of California Foundation in the last three years to have an impact on California communities.

For more news about Blue Shield of California, please visit news.blueshieldca.com. Or follow us on LinkedIn or Facebook.

SOURCE Blue Shield of California