- March 5, 2025
Each year, an estimated $68 billion is lost to Medicare fraud, according to the National Health Care Anti-Fraud Association. In Florida, as much as $2 billion may be lost annually to fraud from the state’s $16 billion Medicaid program, the same organization reports.
Deborah Susswein first learned of the extent of the problem indirectly, through her interest in neurology. She was working as a brain trainer to help students improve their cognitive skills when her father was diagnosed with Alzheimer’s disease.
That diagnosis expanded her interest in neurology, and she began to study the way people’s brains change as they age. She took a few classes and then taught some of her own through adult education.
Eventually, her interest in the brain transformed into an interest in helping the elderly, which led her to the Senior Medicare Patrol, an organization she now volunteers for that acts against health care fraud.
“The more I learned about Medicare fraud and abuse, and the more I saw the scams that were out there, I had to get involved,” she said. “This really is a widespread problem, and it affects everyone who’s paying in to Medicare.”
Susswein held a drop-in session on Medicare fraud at the Flagler County Public Library on Monday. It was the first of three similar events she will hold in collaboration with the Senior Medicare Patrol to help inform Flagler County residents about how to avoid health care fraud.
Fraud and abuse take many forms, Susswein said. For example, medical identity theft occurs when a person steals a Medicare number to use for medical services. Medicaid fraud entails billing for services that were never provided, billing Medicaid for unneeded services or selling a generic prescription but billing Medicaid for the name-brand drug.
Sometimes, scammers will contact potential victims offering to sell them an inexpensive drug plan or will offer to give free medical services to people if they show their Medicare numbers first. Then, the scammer can use the numbers to make Medicare claims.
In her sessions, Susswein answers questions about health care and potential scams, and outlines the following 12 tips for protection against fraud:
• Only visit your personal doctor, hospital or clinic for medical care, and get referrals for special care, equipment or medication from that source only.
• Never show anyone your medical or prescription records without first talking to your doctor or pharmacist.
• If someone calls and tries to pressure you into something, hang up the phone.
• If someone comes to your door and says they are from Medicare or some other health care company, shut the door.
• Talk to your health care provider before buying or investing in Internet products or services.
• Don’t keep mail in your mailbox for more than one day, because people steal personal information from mailboxes.
• Rip up or shred health care documents — or other important documents — before throwing them away.
• Remember that Medicare doesn’t sell anything.
• Follow your instincts about offers that seem too good to be true.
• If you suspect an error, fraud or abuse related to health care, gather the information about the incident and report it by calling 1-866-357-6677.
• Always read your Medicare Summary Notice or health care billing statements to be sure there are no charges for procedures or medications you did not receive, that nothing has been billed twice and that there were no services billed that were not ordered by your doctor.
Susswein will hold her next two sessions from 10 a.m. to 12 p.m. on July 22 and August 26, in the meeting rooms of the Flagler County Library.
