Medicare Prescription Drug Cap Scams

The New York StateWide Senior Action Council's "Medicare Fraud of the Month for January"

ALBANY, N.Y., Jan. 14, 2025 /PRNewswire/ -- The New York StateWide Senior Action Council (StateWide), an organization dedicated to advocacy for the rights of seniors in New York State, today announced its Medicare Fraud of the Month for January: Medicare Prescription Drug Cap Scams.

The StateWide Fraud of the Month is a component of the Senior Medicare Patrol (SMP), the definitive resource for New York State's senior citizens and caregivers to detect, prevent, and report healthcare fraud, errors, and abuse. StateWide is New York's grantee/administrator for this Federal Program.

"As of Jan 1, 2025, Medicare is limiting the out-of-pocket costs for prescription drugs to $2,000 per year for seniors. This cap applies to covered Medicare Part D prescription drugs, making medications more affordable for millions of beneficiaries. However, scammers may try to take advantage of this new program by offering fake services or creating fraudulent schemes," explained Maria Alvarez, Executive Director of StateWide.

Alvarez warned of potential fraud schemes to watch out for:

• Unsolicited calls offering help:
  • Beware of unsolicited phone calls claiming to offer assistance with your Medicare Part D benefits, especially if they ask for personal information like Medicare numbers or bank details.

• "Upfront payments" for new benefits:
  • Scammers may tell you that in order to qualify for the new cap, you need to pay an upfront fee or "processing" fee.
  • No legitimate Medicare program will ask you for payment before you can access benefits.

• There is No Need for Extra Cards or Documentation:
  • If enrolled in a Medicare Prescription Payment Plan, there is no need to show anything extra (like an additional card) when picking up prescriptions at the pharmacy.
  • Current health or drug plans will bill beneficiaries as is custom

How to Protect Against These Scams

• Do not share personal information with unsolicited callers or emails.
• Check Medicare statements carefully for any errors or suspicious charges.
• Guard a Medicare card like it's a credit card.

"We have trained counselors to help educate Medicare beneficiaries in the fight against health care fraud. To report Medicare fraud, errors or abuse you can call our NYS Medicare Fraud Helpline at 800-333-4374 or visit www.nysenior.org," Alvarez concluded.

StateWide also provides information and educational presentations, assistance regarding any Medicare questions, plan comparisons, appeals, billing issues and patients' rights to all seniors throughout New York State.

It is estimated that Medicare fraud costs taxpayers over $60 billion dollars nationally per year. To help combat this illicit industry StateWide announced its Fraud of the Month program in 2022 to highlight these scams being perpetrated on the State's seniors.

This project was supported, in part by grant number 90MPPG01701, from the U.S. Administration for Community Living.

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SOURCE New York StateWide Senior Action Council, Inc.