Local seniors struck hard by Medicare fraud

by Danielle Parker of of Duncanville TODAY

As many seniors know, Medicare Advantage health insurance is in the midst of its annual enrollment period. From Nov. 15 to the end of December, consumers can enroll in a low-cost Medicare plan of their choice. However, several Medicare patients have reported companies that are misrepresenting themselves through deceptive sales tactics.

Medicare Advantage Plan agents have convinced potential patients to switch their plans, with the promise of cheaper cost and more benefits. The problem is many providers do not accept the plans these companies offer, which have left many customers in a helpless situation.

“Seniors are being taken advantage of and this is ruining their lives, especially if they have some type of critical illness,” Carolyn Legg, a patient advocate at Infinite Care Home Health said.

Within the last year, Shirley Pfister, 72, of Cedar Hill has faced multiple surgeries, chemotherapy and countless doctor visits because of cancer. In September, she began a downhill battle with a Medicare Advantage provider.

“A man called and told me about Medicare Advantage. He made it sound so good,” Pfister said.

In a matter of months, Pfister lost all of her home health support and medication coverage. She has tried to resolve what she said was an honest mistake, but has only found more anxiety.

“These people are playing games with my life,” Pfister said. “I am running out of medication and now I have no coverage for it. Nothing is getting done. I have no prescription coverage whatsoever. I don't know what is going to happen from here. I am at my breaking point.”

Nancy Mitchell of Cedar Hill has found herself at this same point. Her mother was also victim of Medicare Advantage fraud.

“In 2006, my mother received a letter that said if she did not sign up for the Medicare Advantage she would lose her Blue Cross Blue Shield benefits. They stated that the only thing that was going to change was the billing process, but things did change.

“When we began having problems, the provider only had excuses. I could never get a straight answer,” Mitchell said. “I spoke with them for several hours and they reassured me that it was not an HMO, but Private Paid For Service, which included Home Health Care. But our home health provider never received anything.”

In the end, Mitchell's mother lost all her benefits, coverage, provisions for breathing machines and medication and eventually her life.

“Medicare Advantage has been one of the biggest disadvantages,” Mitchell said. It has been very stressful. My mother passed away in August and I still have to deal with this. They still have not paid several providers, and there are a couple thousand dollars worth of bills.”

As a registered nurse, Mitchell was able to give her mother a lot of the care she needed, but she said that she is worried about others who are not as fortunate to have family around.

“My concern is not only what is happening to me and what happened to my mother, but what about those who do not have anyone?” Mitchell said. “A person who is elderly in this position would literally be up a creek without a paddle. My mother was left with nothing.”

The Texas Department of Insurance is alerting consumers to be cautious of these procedures, despite the inexpensive plans they claim to offer. Not all Medicare Advantage companies have used fraudulent and deceptive conduct, but consumers should weigh their options carefully. If they are unable to make an informed decision, family members should be involved in the decision process.

“Have a trusted friend or family member with you when you speak with a salesperson,” Legg said. “Always talk to a relative or reliable friend, if you do not completely understand. This is a complex decision and should not be taken lightly.”

If you believe that you have been misled or pressured into enrolling in a Medicare Advantage plan, or enrolled in a plan without your knowledge, call the Medicare Help Line at 1-800-633-4227 or visit www.medicare.gov.