B-Informed Blog

B-Informed Blog


Enriching your life; informing your health. Life insurance, and other topics.

Deep Dive: Medicare Fraud and Abuse Part 3
Deep Dive: Medicare Fraud and Abuse Part 3

Medicare is one of the most popular government run programs in the nation. Every day, 10,000 Americans enroll in Medicare and around 37 million rely on Medicare for their preventative health services like flu shots and cancer screenings.

According to the Kaiser Family Foundation, 6 in 10 Americans report that the program is working well. That number climbs when you look at seniors, 8 out of 10 of whom believe Medicare works well for them. But working well and working perfectly are two separate things.

A major flaw in the Medicare program is the risk for both fraud and abuse. Fortunately, there are ways for concerned seniors to help combat both, thanks to the Senior Medicare Patrol.

What Is the Senior Medicare Patrol (SMP)?
The SMP is a network of specially trained volunteers who seek out evidence that abuse or fraud has occurred and report it to the proper authorities. In doing this, the SMP helps to prevent undue burden on the Medicare system that could potentially cause a rise in the price of senior health care.

Who Are the Volunteers?
The vast majority of the roughly 5,000 nationwide volunteers are civic-minded Americans who are retired and on Medicare. Like a neighborhood watch, these volunteers are among the first defense against the sort of fraud that could have devastating effects on the Medicare system.

What Do SMP Volunteers Do?
SMP volunteers are responsible for a number of services geared towards improving the life of Medicare beneficiaries and their families. Among the most common tasks are:

  • Help with administrative tasks like data entry and more.
  • Provide community outreach by supplying senior centers and events with informational materials about Medicare fraud and abuse.
  • Give presentations about the risks of Medicare fraud and abuse, and how best to detect them.
  • Counsel fellow seniors struggling to make sense of their situation. This might even include reviewing personal information, preventative health services records, and looking out for red flags that abuse or fraud might be occurring.

Whether you are looking for a way to help combat the issues of insurance fraud and abuse, or you are looking for a way to find out if you yourself might be at risk, SMP offers a number of services and opportunities that might interest you. To learn more about this important program, visit the official website.

This concludes our three-part series on Medicare fraud and abuse. Knowing what to watch out for can make a real difference in your risk of being taken advantage of.

If you have any additional questions, give us a call at Bankers Fidelity at (866) 458-7500.


The Commonwealth Fund, "Medicare's Numbers Game," April 2015

The Henry J. Kaiser Family Foundation, "The Public's Health Care Agenda for the 113th Congress," January 2013

Senior Medicare Patrol, "Become a Volunteer"

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Deep Dive: Medicare Fraud and Abuse Part 2
Deep Dive: Medicare Fraud and Abuse Part 2

The number of people enrolling in Medicare is rising from 39.7 million in 2013 to 55.7 million in 2015. In fact, according to the CommonWealth Fund, there are projected to be 81 million enrollees by 2030.

The second part of this Medicare fraud and abuse series is designed to examine some of the most common ways that Medicare fraud and abuse manifest themselves.

Billing Fraud
This is a common abuse perpetrated on Medicare patients. This is when a medical facility bills you or the government for a service, treatment, or medication you never received. The guilty party can be your doctor padding your claims to increase their profit or it can be the result of identity theft.

No Medical Necessity Fraud
No Medical Necessity Fraud can be one of the most difficult to identify. In a typical case, a medical provider will submit a claim for medications, ambulatory services, or medical devices that the patient did not actually need. In extreme cases, victims can even be subjected to dangerous surgeries with little to no possible benefit. While it helps unscrupulous providers pad their pockets, it puts patients at risk and places extra costs on the Medicare system. Since most patients are inclined to trust their doctor's opinion, it can be difficult to know whether a given medical procedure is actually necessary.

Procedure Unbundling
Many important surgeries are made up of a number of essential steps, but each step is considered part of the larger procedure -- they are bundled. But many times, a doctor can receive a greater amount of money by billing for each individual step separately. By doing this, the doctor can increase their own profits, leaving you and the Medicare system will be facing an undue burden.

Pharmaceutical companies have huge profit margins on many of their basic products, despite the availability of less expensive generic options. That is because the pharmaceutical reps often provide incentives for doctors to prescribe their medications, including financial benefits, among other things. At its worst, doctors will prescribe medication that offers no real benefit for a patient in order to fulfill their part of the agreement made with the pharmaceutical companies.

There are a number of different ways Medicare and Medicare Advantage patients may be defrauded. While the fraud might seem harmless to some, certain kinds may have life threatening results for the patient. But don't worry, in the next blog of this series, we will look into what you can do to prevent health care fraud.


The Commonwealth Fund, "Medicare's Numbers Game," April 2015

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Deep Dive: Medicare Fraud and Abuse Part 1
Deep Dive: Medicare Fraud and Abuse Part 1

Medicare open enrollment season, which runs between October 15 – December 7, 2017, is fast approaching. During this time thousands of Americans will be applying for benefits. While Medicare and Medicare Advantage offer benefits to millions of people, fraud and abuse are two issues that adversely affect Medicare and the people who depend on it. In fact, a 2015 report found that as much as $60 billion was lost through Medicare fraud in 2014.


In this three-part post, we will take a close look at health insurance fraud and abuse, how they happen, and what you can do to prevent them. In this first post, we will explain what Medicare fraud and abuse are and, more importantly, why they matter.

What Is Medicare Fraud?

To put it simply, one type of Medicare fraud occurs when someone knowingly makes a false claim for services and procedures that never happened. That means your doctor or another party is charging the Medicare system for services never rendered. Because health care providers are reimbursed by the government for treating Medicare patients, it is a potentially lucrative form of fraud that costs taxpayers billions every month. We will dive deeper into the types of Medicare fraud in post two.


What Is Medicare Abuse?

Medicare abuse is a little different. One example is when a doctor administers treatments or procedures that do not truly benefit a patient. These procedures can range from unneeded but harmless prescriptions to potentially deadly surgeries. In this case, work is being performed by the doctor, but the work was not necessary. Medicare abuse exposes patients to unnecessary risk.


Why Should Anyone Care?

People seem to care more about Medicare abuse because it can have a negative impact on a person's life, even resulting in death. But fewer people seem worried about Medicare fraud. All too often, it's seen as a victimless crime. That simply isn't true. As tax payers, it's your money being stolen and wasted.


Plus, every unnecessary cost to Medicare results in an undue burden on the Medicare system as a whole, which then results in higher premiums and health care costs for everyone who relies on the program.


That's why Medicare fraud should be a concern for every American, whether they pay for private insurance or are on Medicare. In the next post, we will examine the most common methods of Medicare fraud and abuse.



ABC News, "Medicare Funds Totaling $60 Billion Improperly Paid, Report Finds," July 2015

Medicare Consumer Guide, "Preventing Medicare Fraud"


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Life Insurance Glossary: 5 Terms You Should Understand
Life Insurance Glossary: 5 Terms You Should Understand

Selecting life insurance can be difficult. Even beyond the typical struggles that many people face with estate planning and other related matters, the numerous terms and policy options for life insurance can make the buying process very difficult.


But despite that difficulty, life insurance can be very important. In fact, 86% of respondents to a study agreed that the vast majority of people should have at least some amount of life insurance coverage.


In order to better help you navigate the life insurance purchasing process, we've put together this glossary of terms that you should be familiar with.


Death Benefit: The death benefit is the money that your beneficiaries receive upon your death. When you're purchasing life insurance, you can select the amount of your death benefit coverage. Alternate terms include Face Amount, Policy Value, and Payout.


Term Insurance: The word “term” refers to the duration of your policy or how long it is in effect. Term Life Insurance policies have a set date at which they terminate, so it is important that you pay attention to the length of your term.


Premium: Think of it as the amount you pay at to keep your benefits in force; something that you need to pay on a regular basis. The frequency of premium payments can vary (monthly, quarterly, etc.).


Beneficiary: Your beneficiary is the person who will receive your death benefits after you pass. Some options for choosing your beneficiary may include choosing one person to receive your benefits or you may split your benefits among a number of people. Alternatively, you can choose an organization, trust, or charity to receive your benefits.


Risk Class: When it comes to life insurance plans, applicants are often sorted in terms risk. Factors that are considered include age, sex, height, weight, family history, personal medical history, and tobacco use. The risk class you're in can have a direct impact on how much you're required to pay for your insurance. Maintaining a healthy lifestyle can improve your risk class.


Purchasing life insurance can be confusing: there's a myriad of considerations and terms that you're expected to contend with. For further information contact Bankers Fidelity with any questions you may have about life insurance. Our team of professional, independent agents can help get you the right policy for your needs.



BestLifeRates.org, "2016 Life Insurance Statistics and Facts"


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Understanding Life Insurance and the Special Needs Trust: Part 2
Understanding Life Insurance and the Special Needs Trust: Part 2

While it can be difficult to have to think about caring for your family after you pass, doing so when you are responsible for a loved one with disabilities is even more difficult. In order to alleviate some of your concerns, we have put together this two-part series about Special Needs Trusts.


In the first post of this two-part series, we defined the basics of what a Special Needs Trust is and it’s benefits. In this second part, we will discuss how you can set one of these trusts up using your life insurance policy.


Funding your Special Needs Trust

As we mentioned in the last post, this type of trust is designed to help support your loved one living with disabilities without affecting their government benefits like Social Security, Medicaid, or Medicare. To do this you will need to put money in the trust, but where does it come from?


There are a number of ways you can use your savings, investments, or even your will to fund your trust. One of the best and surest ways to fund your trust is with your life insurance plan. Some of the many benefits of using your policy include:


You can get an excellent value for your money because your monthly premium can help secure a significant death benefit.

You may avoid excess income and estate taxes if your family structures your trust correctly. You have much more control over how your estate is split among your surviving family members.


By using your life insurance to set up a Special Needs Trust, you are providing your loved ones with the resources to lead a full life even after you pass.

Bankers Fidelity is a leader in providing affordable term life insurance in Texas, Iowa, Indiana, and 43 other states (plus DC). If you have questions, contact our agents for life insurance in the state that best applies to your location.



  1. BestLifeRates.Org

  2. American Bar Association


This article is for informative purposes only and not intended to provide legal or tax advice. You should consult with an attorney or tax accountant for professional education.


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