NILES — On Monday, experts from the Region IV Area Agency on Aging visited First Presbyterian Church to share tips on getting caught in a fraud.

Mistelle Smith is a regional coordinator for the Michigan Medicare and Medicaid Assistance Program and specializes in Medicare fraud. Smith presented on the topic, emphasizing that it was not only something that impacts seniors, but anyone who has personal information to protect.

Smith outlined a few scams that people, especially those with Medicare or Medicaid, should be aware of. She said a number of scams occur when someone claiming to be with Medicare or Medicaid call an individual and asks for their personal information. Using this information, a scammer can then fraudulently bill someone’s account, draining money out of the system.

“Medicare is not going to call anybody directly,” Smith said. “Just being aware that you should be very protective of your Medicare number and any of your personal information just like it is your credit card.”

One way to determine the legitimacy of any call asking for private information, Smith said, is to ask for the person’s name and contact information and offer to call them back at another time. If they are not conducting a scam, they should be willing to have the individual call them back at another time. However, a scammer is not going to pass along a name and number to be reached at a different time.

Christine Vanlandingham, a products development officer with the Region IV Area Agency on Aging who also presented key information, said the organization runs an information and assistance line, fielding thousands of calls every year.

“Fraud abuse, questions about Medicare and Medicaid are high on the list in seniors’ minds,” Vanlandingham said. “When we got this request for a community presentation, certainly it fit high in what we already knew was an issue in the community. When there is a need in the community, we want to make sure people have access to expertise and know where to go to get unbiased information to get fraud and abuse.”

The two also discussed fraud that can be conducted through medical billing. They advised everyone to check their statements and explanation of benefits to compare them to the medicine and treatment they had received to make sure that they are being billed for something they actually received. Another way scammers will steal money is by sneaking in services or prescriptions that a person did not need. Sometimes these issues can be a mistake, but either way it needs to be rectified, Smith said.

“I always suggest to people that if they have a question or concern on any bill, always call and ask about it,” Smith said. “Not necessarily that it is something fraudulent, but it could be a mistake. There are a lot of dollars spent on inappropriate mistakes and billing.”

Catching such a mistake or scam saves not only the individual from the headache of having to pay money on something they don’t owe, it also keeps providers from having to spend extra funds and man power. According to Vanlandingham, between 3 and 10 percent of health care spending is lost to fraud.

To counter these fraudulent attempts, Smith suggested keeping a medical journal and counting pills to make sure the correct amount is in the bottle.

While Vanlandingham and Smith said they do not have data on the number of fraudulent phone calls or incidents, they said that last year, the Senior Medicare Patrol reported that about $44 million that was taken fraudulently in Michigan was recovered. The funds were returned to beneficiaries who were victims of the scams. 

Overall, there are three principles Vanlandingham and Smith advise residents follow: protect, detect and report.

“Protect your information and then report it if you find an issue,” Vandlandingham said.

There are several numbers that people can call for more information and to report suspected fraudulent behavior.

Those numbers include:

Office of Inspector General:

• Waste, Fraud, and abuse: 800-447-8477

• Michigan Medicaid Fraud: 855-643-7283

• Medicare fraud: 800-803-7174 OR 800-633-4227

• Social Security Fraud: 800-269-0271

Smith and Vanlandingham also encouraged community organizations interested in having a presentation about the topic to contact counselors with the Michigan Medicare and Medicaid Assistance Program, at 800-803-7174.

“We want folks to know there is a place to turn and local folks they can get connected with,” Vandlandingham said.