Published in RINewsToday on June 8, 2026
As skyrocketing Medicare fraud schemes cost taxpayers billions each year, congressional leaders, federal agencies, and consumer advocacy groups intensify their efforts to combat aggressive scams targeting older Americans.
Experts estimate that Medicare fraud, waste, and abuse may cost as much as $60 billion annually. However, no federal agency publishes a definitive total amount because much of the activity goes undetected.
The growing incidents of Medicare fraud, waste, and abuse framed the discussion on June 3, 2026, at the Leon Mathieu Senior Center in Pawtucket, where more than 40 older adults gathered for the Fifth Annual Medicare Fraud Prevention Week event.
During the 75-minute presentation, three federal officials shared valuable information with the attending Medicare beneficiaries, designed to increase their awareness of fraud tactics and equip them with practical strategies to safeguard their personal and health care benefits.
The afternoon program was hosted by Rhode Island’s Senior Medicare Patrol (SMP), along with special agents from the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG), the Centers for Medicare and Medicaid Services (CMS), and the City of Pawtucket.
At the gathering, municipal, state, and federal leaders warned that Medicare recipients remain primary targets of fraudsters who use fake medical claims and identity theft. Specific types of fraud were highlighted, including durable medical equipment (orthotic braces, urinary catheters), genetic testing, and fraudulent billing by medical providers.
Learning to Spot the Warning Signs
Christine Anderson, Health Information Manager at the Rhode Island Office of Healthy Aging (OHA) and the leader of the state’s SMP program, said the program’s goal is to provide beneficiaries with practical tools to protect themselves and encourage them to be more proactive in reporting suspicious fraud activity, potentially reducing the success rate of scams within Rhode Island.
Anderson emphasized that scammers will often pose as representatives of Medicare, Social Security, or local human services offices to obtain or confirm Medicare numbers, which can be used to bill for unnecessary durable medical equipment such as back or knee braces.
SMP’s Program Manager urged attendees to review their Medicare Summary Notices (for Original Medicare) or their Explanation of Medical Benefits (EOMB), and to seek assistance from the SMP program and the Leon Mathieu Senior Center (or their local senior center) if they see unfamiliar charges.
“If something doesn’t look right, ask questions,” Anderson urged.
“We are grateful to the OHA, HHS-OIG, CMS, and the SMP for bringing this important information directly to our residents,” Donald R. Grebien, Mayor of Pawtucket said. “Education and awareness are critical in protecting older adults and preserving the integrity of the Medicare system.” It is one of the strongest defenses against scams targeting older residents,’ he says. Grebien pointed out that fraud can threaten both the financial security and well-being of seniors.
Echoing Grebien’s sentiment, Elizabeth Moreira, Pawtucket’s Deputy Director of Administration, said community education is key, stressing that awareness of the growing prevalence of scams is one of our strongest tools for preventing fraud. “Events like today give our community and caregivers the tools they need to recognize warning signs, protect their personal information, and report fraud before it can harm them,” Moreira said.
Federal Enforcement Efforts
HHS-OIG Special Agent Victoria Mens and Assistant Special Agent Lindsay Walford described their federal agency’s role in investigating fraud, waste, and abuse across more than 100 HHS programs, including health, social, and Medicare and Medicaid programs.
The federal agents also explained how they fight Medicare fraud, waste, and abuse.
They highlighted how the Office of Audit Services and the Office of Evaluation and Inspections publish reports on systemic problems including nursing homes lacking emergency power and using antipsychotic drugs to control residents.
To safeguard $2 trillion in federal healthcare funds, HHS-OIG conducts audits, evaluations, and criminal investigations.
The federal officials also cited prosecutions involving overbilling for medical equipment, large-scale catheter fraud schemes, and psychiatric billing for services that were never provided.
One of the most costly schemes involving urinary catheters was estimated to have resulted in attempted losses of about $4.5 billion, notes Walford.
During the presentation, Walford cited a Rhode Island case. She noted that Zynex Medical allegedly overbilled multiple payers about $873 million for TENS units and excessive supplies, leading to criminal charges against company leaders and a non-prosecution agreement with the company.
“A lot of that has been stopped, and so that money hasn’t all gone out, but that’s the tune and counting as to how much they’re attempting to pull out of the Medicare Trust Fund,” Walford said. She gave an overview of HHS-OIG accomplishments. Between April and September 2025, OIG work led to $2.2 billion in recoveries through settlements and criminal restitution. The agency said it returns nearly $13 for every dollar spent on oversight.
During the same period, investigators completed more than 900 investigations and issued hundreds of recommendations to prevent improper payments, says Walford.
Protecting Yourself
Mens urged seniors to treat their Medicare number with the same care as a Social Security number. “Don’t give out that information,” she warns. “If someone calls claiming to be from Medicare or says they are your healthcare provider, hang up and call back using a number you know is legitimate,” she says.
“Scammers rely on urgency,” Mens said. “Take time to talk with a family member, Medicare representative, or healthcare professional before making any decisions,” she says.
Jennifer Syria, Regional Administrator for the Centers for Medicare & Medicaid Services, pointed out that beneficiaries play a critical role in preventing fraud. “When you review your statements and notice unfamiliar charges, you become a valuable investigator in preventing fraud,” Syria said.
Syria encouraged residents to report suspected fraud and have key details ready, including provider names, dates of service, payment amounts, and Medicare Summary Notices.
“If you suspect you are a victim of fraud, our trained staff can meet with you to help resolve the issue,” says Mary Lou Moran, Director of the Leon Mathieu Senior Center. If you need assistance, call 401-728-7582. Moran notes that protecting yourself comes down to three key actions: prevent, detect, and report.
For more details about Rhode Island’s Senior Medicare Patrol program, call (401) 1-888-884-8721.
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Home Foot Care Legislation Gains Momentum Toward Passage in RI
Published in RINewsToday on April 13, 2026
Through the efforts of aging advocates and older Rhode Islanders, the House last week followed the Senate’s lead in passing legislation that would allow certified foot care nurses to provide routine foot care to homebound patients. Under the legislative proposal, nurses must receive proper training and certification and demonstrate clinical competency.
At press time, the two chambers must still reconcile and pass identical versions of the bill before the legislation can be sent to the governor for signature.
On April 7, the Senate unanimously passed S. 2116A, introduced by Sen. Lori Urso, to expand access to routine foot care for homebound patients. Two days later, the House followed suit, passing Rep. Jennifer Boylan’s H 7029A by a vote of 65–0.
The sponsors—Rep. Boylan (D-Dist. 66, Barrington and Riverside) and Sen. Urso (D-Dist. 8, Pawtucket) —say the legislation addresses a critical need for basic, preventive foot care in the home. Many elderly and disabled patients require assistance with services such as toenail care and treatment of corns and calluses, yet are often unable to access care outside the home, including visits to a podiatrist.
Under the legislation, nurses must demonstrate knowledge and clinical competency in foot and nail structure and function, common foot conditions, and appropriate care techniques. They must also be certified by a national professional organization, such as the American Foot Care Nurses Association (AFCNA), or an equivalent approved by the Rhode Island Department of Health. Additionally, two of the required 10 continuing education hours per certification period must focus specifically on foot care. In addition to CEUS, 30 hours of training with a podiatrist are required for certification.
“This bill is about expanding access for vulnerable Rhode Islanders who currently have no safe options for routine foot care,” said Sen. Urso. “While this care may seem simple to some, for others it is difficult or even impossible to perform safely on their own.” She noted that similarly trained nurses already provide this care in most other states, including Massachusetts, whose regulations served as a model for the legislation.
Urso also pointed to the state’s aging demographics. “With the City of Pawtucket joining the AARP Age-Friendly initiative, along with several other Rhode Island communities, it is imperative that we support residents who wish to age in place,” she said. “Rhode Island has more residents over age 65 than under age 20, and initiatives like this help meet their needs.”
Rep. Boylan emphasized the broader issue of healthcare access. While many Rhode Islanders are aware of shortages in primary care and specialty providers, she said, fewer realize that essential services like in-home foot care are largely unavailable. This gap leaves many older adults without safe options.
“It’s especially dangerous for individuals with diabetes, who are prone to infections and other foot problems that can lead to serious complications or even death,” Boylan said.
Strong Backing from Leadership and Advocates
House and Senate leadership, along with aging advocates, say the proposal addresses a longstanding gap in home- and community-based care.
“This legislation will provide a lifeline for vulnerable Rhode Islanders who rely on in-home health services and currently face significant barriers to receiving basic but essential foot care,” said Senate President Valarie J. Lawson. She described the bill as a common-sense solution that improves the quality of life for both patients and caregivers.
House Speaker K. Joseph Shekarchi called the measure a practical response to a widespread problem. “As someone with diabetes, I understand the serious risks associated with a lack of routine care. This bill helps protect the health and safety of Rhode Islanders,” he said.
Tina McDonald, a registered nurse licensed in both Rhode Island and Massachusetts who is certified in foot care, testified in support of H. 7029A. With 12 years of experience in foot care nursing, she argued that there is a significant unmet need among homebound elderly and chronically ill residents who can no longer visit a podiatrist’s office.
“It’s not a question of doctor versus nurse. It is a matter of nurse versus no one,” McDonald told House lawmakers, warning that podiatrists are not filling this gap in care.
Addressing the primary opposition from podiatrists, she clarified that nurses would not be practicing medicine but instead addressing a “self-care deficit” within the established nursing scope of practice.
During her testimony, McDonald emphasized that nurses are highly trained in assessment, infection control, and wound care.
Carol Anne Costa, executive director of the Senior Agenda Coalition of Rhode Island (SACRI), said the legislation would benefit homebound and mobility-challenged residents and their caregivers.
“SACRI was proud to testify in strong support of this bill,” she said. “It represents a vital step toward ensuring that older adults have the care and support they need to age safely and with dignity in their communities.”
Costa noted that allowing trained nurses to provide limited foot care services at home supports both family caregivers and broader home- and community-based care systems. “Those needing these services are often older adults or individuals with disabilities who face mobility challenges, making it difficult to access care outside the home,” she said.
She added that aging and underlying health conditions can make nail care more difficult and increase the importance of proper foot care.
Catherine Taylor, AARP Rhode Island State Director, echoed those concerns. “Access to in-home foot care is critical for older adults facing mobility, vision, or chronic health challenges,” she said. “Without regular care, minor issues can progress into infections, pain, or mobility limitations that increase fall risk and lead to more serious conditions. Home-based care supports prevention, early detection, and aging in place.”
“The bill would provide relief not only to patients, but also to families and caregivers who are often forced to choose between going without care or attempting to provide it themselves,” Taylor added.
Mary Lou Moran, director of the Pawtucket Division of Senior Services at the Leon Mathieu Senior Center, highlighted the local impact.
“This bill removes unnecessary barriers to essential preventive care and helps close a significant service gap,” she said. “Many individuals we serve cannot safely perform their own foot care and face transportation, mobility, or financial challenges accessing clinic-based services.”
Moran added that regulated, in-home care provided by qualified nurses can help prevent avoidable complications, reduce healthcare costs, and improve quality of life.
Podiatry Association Flags Concerns
Following House passage of H 7029A, the Rhode Island Podiatric Medical Association (RIPMA) issued a statement acknowledging improvements in the bill while raising concerns.
“This issue has always been about ensuring patients can access care from certified and credentialed providers,” the statement read. “We appreciate the inclusion of language requiring nurses to be certified by an accredited organization approved by the Department of Health.”
The organization noted that the bill could benefit truly homebound patients by reducing the risk of self-injury, but emphasized that it is not a substitute for physician care. Patients who can access a podiatrist (in the home or office)—especially those with underlying medical conditions—should continue to receive regular professional treatment.
RIPMA also cited studies showing that Medicare patients with diabetes who receive podiatric care experience fewer hospitalizations and amputations. The group expressed interest in collaborating with certified nurses to ensure safe, appropriate care.
At the same time, Past RIPMA President Dr. Michael Reuter, DPM, FACFAS, voiced concerns about the legislation’s broader impact.
“The legislation aims to solve a problem, but I am concerned it may create new ones,” he said.
Reuter, a board-certified podiatric foot and ankle surgeon in Rhode Island, criticized the absence of a Rhode Island Department of Health recommendation requiring collaboration between nurses and podiatrists. He said such coordination is essential to ensure timely referrals when needed.
“I hope the Department of Health establishes strong safeguards and oversight for providers entering vulnerable patients’ homes,” he said.
He also noted potential cost implications. “Patients will have to pay out of pocket for these services, whereas visits to a podiatrist—whether in-office or through a home visit—are covered by insurance,” he said.
Here is the link to the Feb. 10th House Committee on Health and Human Services on H 7029 A, go to House Committee on Health & Human Services – RISE: 2-10-2026
Here is the link to the March 3rd Senate Committee on Health and Human Services on S. 2116 A, go to Senate Committee on Health & Human Services: 3-3-2026
The ABCs of Surviving Medicare Open Enrollment
Published in RINewsToday on October 20, 2025
It’s that time. The Medicare Open Enrollment period began last week and runs until December 7th. During this period, Rhode Island’s 243,000 Medicare beneficiaries (data from late 2024 to early 2025) are encouraged to explore their Medicare options, carefully review, compare options, and make necessary changes to their existing Medicare plan for the following year.
During the Medicare Open Enrollment period, you can join a new Medicare Advantage plan or Part D prescription drug plan, switch from Original Medicare to Medicare Advantage, or switch from Medicare Advantage to Original Medicare (with or without a Part D plan).
You can make as many changes as you want during this period. The last change you ultimately make will take effect on January 1, 2026.
Medicare Options
According to Healthinsurance.org, an independent website that provides consumer information and education on health insurance options, here’s a snapshot of Medicare plans chosen by Rhode Island beneficiaries.
As of September 2024, 144,610 Rhode Islanders were enrolled in Medicare Advantage plans. These plans, offered by private health insurance companies, are alternatives to Original Medicare. Medicare Advantage plans cover all the healthcare benefits that Original Medicare covers (e.g., hospital services and outpatient/medical/physician services), but the out-of-pocket costs can differ significantly, as Advantage plans set their own co-pays, co-insurance, and deductibles (within parameters defined by CMS).
Approximately 115,000 to 120,000 Rhode Islanders are enrolled in Original Medicare, representing about 49-51% of the state’s Medicare beneficiaries. Original Medicare, covering individuals aged 65 and older as well as certain younger people with disabilities, is a “fee-for-service” plan composed of two main parts: Part A for hospital insurance (covering inpatient hospital care, skilled nursing care, hospice care, and some home health services) and Part B for medical insurance (covering doctor visits, preventive care, and durable medical equipment). These two parts cover a wide range of medically necessary services, with beneficiaries paying a portion of costs, such as coinsurance and deductibles.
Medicare Part D is an optional prescription drug benefit offered by private insurance companies approved by Medicare. This benefit helps cover the cost of outpatient prescription medications. Approximately 83% of the total 243,377 beneficiaries in September 2024 have some form of prescription drug coverage through a Medicare Part D plan.
Finally, according to the U.S. Centers for Medicare & Medicaid Services, as of 2024, more than 50,000 Medicare beneficiaries in Rhode Island had Medigap policies. These policies are standardized supplemental insurance plans sold by private companies to cover the “gaps” in Original Medicare (Part A and Part B), including deductibles, co-payments, and co-insurance.
Taking a Close Look at Your Current Coverage
Even if you’re satisfied with your current coverage, the state’s Office for Healthy Aging recommends that Medicare beneficiaries closely review and compare their Medicare options to ensure their needs are met in the upcoming year. “Medicare beneficiaries will receive a lot of mail during Medicare Open Enrollment so it is very important to pay attention to any changes in the plan’s costs, including premiums, deductibles, and cost-sharing amounts. Make sure your providers and pharmacies are still in the plan’s network.”
All Medicare beneficiaries (or those approaching Medicare eligibility) can receive free, unbiased counseling from State Health Insurance Assistance Program (SHIP) counselors. These services are voluntary and meant to help people understand the complexity of plans and make informed choices. SHIP counseling is an offered resource, not a condition of having Medicare or enrolling in a plan.
What to Bring to Your SHIP Appointment
You can enroll in Medicare plans or manage your coverage without using OHA or SHIP partners’ counseling. There is a risk of not choosing the best plan to meet your medical needs, missing savings or subsidies, and increasing stress or confusion in making the right choice.
After making an appointment, a SHIP counselor will request the beneficiary bring their Medicare card, current plan(s) cards, and a list of prescriptions and doctors to the meeting.
The OHA and its nine partners (see box below) are provided with training, certifications, and resources through the federal SHIP grant ensuring they stay up to date on what every Medicare Advantage, Traditional Medicare, and Medicare Part D plan offers.
Every October, OHA and its SHIP partners meet with presenters from Rhode Island’s Medicare Advantage plans to become aware of updates on all the 2026 plan changes.
Changes in 2026
According to AARP, expect some significant changes in 2026. The first Medicare-negotiated drug prices will go into effect for drugs like Eliquis, Jardiance, Xarelto, Januvia, Farxiga, Entresto, Enbrel, Imbruvica, Stelara, and NovoLog/Fiasp. Additionally, according to CMS, savings are expected to lower enrollees’ out-of-pocket spending by an estimated $1.5 billion next year. Finally, the new cap on annual out-of-pocket expenses for Part D drugs will increase to $2,100.
You can call 1-800-MEDICARE to make changes by phone. You can also use Medicare’s Plan Finder tool to compare plans at www.medicare.gov/plan-compare to compare options and enroll in some plans online. Alternatively, you can contact plans directly to enroll.
| Find a Medicare plan |
However, the Office of Healthy Aging cautions, “Unfortunately, we are still waiting for CMS to release some of the 2026 cost and premium changes, and due to the government shutdown, this may be further delayed.”
A Final Note… Beware of Scams and Fraud
Open Enrollment is also prime time for scams. Scammers who claim to represent Medicare may call asking for your Medicare number, Social Security number, or bank information, especially before you enroll. Medicare will never call, email, or text out of the blue to ask for personal information or payment. If you’re unsure, hang up and call 1-800-MEDICARE to verify.
To schedule an appointment with a State Health Insurance Assistance Program (SHIP) Counselor please contact one of the below agencies.
| PARTNER AGENCY | LOCATION | PHONE NUMBER |
| Aging Well | 84 Social St, Woonsocket, RI 02895 | 401-766-3734 |
| Johnston Senior Center | 1291 Hartford Ave, Johnston, RI 02919 | 401-944-3343 |
| Westbay Community Action Agency | 487 Jefferson Blvd, Warwick, RI 02886 | 401-921-5237 |
| South Kingstown Senior Center | 25 St Dominic Rd, Wakefield, RI 02879 | 401-789-0268 |
| Westerly Senior Center | 39 State St, Westerly, RI 02891 | 401-596-2404 |
| The Aging & Disability Resource Center (ADRC) | 50 Valley St, Providence, RI 02909 | 401-462-4444 |
| East Bay Community Action Agency | 100 Bullocks Point Ave, East Providence, RI 02915 | 401-435-7876 |
| Leon Mathieu Senior Center | 420 Main St, Pawtucket, RI 02860 | 401-728-7582 |
| Progreso Latino | 626 Broad St, Central Falls, RI 02863 | 401-728-5920 |
| Edward King House | 35 King St, Newport, RI 02840 | 401-846-7426 |
Source: OHA, Oct. 2025
Herb Weiss 