Is Every Phone Call about Medicare in Massachusetts a Scam?

(For more on the national implications of health care reform on United States Medicare, and information on other Medicare issues, see theabcsofmedicare blog here.)

There is a story circulating, particularly in Western Massachusetts, about a Medicare phone scam. The link is to a local TV station but I have seen similar information on Facebook and on the web site of the Springfield Republican newspaper.

This may not be a scam. I have no idea what the TV reporter means when he or she writes

"Police explain that Medicare has confirmed these calls are not coming from them and will not call subscribers."

 

Did the reporter not understand what the police are saying or are the police wrong or is there really a scam? This little article appearing in multiple places will cause harm to the senior community if someone in the media doesn't do the right thing and get more information.

Here are some possibilities:

1. It is true that Medicare "will not call subscribers" if by Medicare the reporter and/or the police means the Centers for Medicare and Medicaid Services (CMS). That's because claims from people with fee for service (FFS) Medicare in Massachusetts -- typically with a supplement such as Blue Cross Medex Bronze -- are handled by the Wellpoint Insurance Company of Indiana, which subcontracts some of its Massachusetts work to the National Heritage Insurance Company of Dallas with its local office in Hingham. It is virtually certain that none of these three private insurance companies (Wellpoint, National Heritage, or Blue Cross) would call a senior about a Medicare FFS claim. They deal with the providers and then each other and just send Medicare beneficiaries through the mail those mounds of paper they get after they go to the doctor's or hospital. But the fact that it is these insurance companies that handle FFS Medicare claims -- not CMS -- that means "Medicare" will not call subscribers. And Blue Cross or whomever sells a senior his or her supplemental so-called Medigap insurance might call him or her for some marketing purpose.
2. But people on Medicare with CMS-approved capitated Part C Medicare health plans are called by their insurers all the time. That applies to about 20% of the people on Medicare in Massachusetts. Examples include Health New England, Tufts and others. And some of the insurance companies -- like Blue Cross -- that sell supplemental policies to FFS Medicare beneficiaries also sell Part C Medicare health plans.
3. Some of these CMS-approved capitated Part C Medicare health plans do make house calls as part of their efforts to control health care costs. Typically it would be a nurse or PA and not a doctor who would come to the house. But it is possible that this is the source of the phone calls, not scammers.

I agree seniors should be leery about any phone calls but I don't see the scam here; nothing in the story says they asked for a Medicare number or credit card number. There is not much money in door-to-door scamming. But my overall point is simply that the media ought to get the story straight before printing something like this short uninformative article that will do nothing but possibly unnecessarily scare seniors.