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.
Tag Archives for Office of Health Aging
Tracking legislation of interest to seniors as RI General Assembly wraps up – Herb Weiss
Published in RINewsToday on June 28, 2021
In the waning days of the 2021 legislative session, RI House lawmakers approved a $13.1 billion state budget for the 2022 fiscal year (by a party-line vote of 64 Democrats to 10 Republicans) that boosts key supports for vulnerable Rhode Islanders — particularly affordable housing and social services— without imposing any broad-based tax increases.
The budget plan also fully funds K-12 education, boosts support for higher education, restores funding to Eleanor Slater Hospital and funds a first-of-its-kind statewide program for police body cameras.
Additionally, the budget codifies the state’s existing Livable Home Grant Program to provide subsidies (up to 50%) for certain disability and accessibility home modifications, which will enable older people to remain in their homes. The budget includes $500,000 for the Livable Home Grant Program.
At press time, the state budget moves to the Senate for consideration. Once passed by the upper Chamber and signed into law by Gov. Dan McKee, the budget covers the new fiscal year, beginning July 1.
In the Waning Days…
According to Larry Berman, the House’s Communication Director, 1,470 bills were introduced in the House and 978 in the Senate. According to the RI General Assembly’s bill tracker, less than 30 are identified as directly related to seniors.
Here is a sampling of these bills:
The Nursing Home Staffing and Quality Care Act, sponsored by Senate Majority Whip Maryellen Goodwin (D- District 1, Providence) and Rep. Scott A. Slater (D-District 10, Providence), sets minimum staffing levels for Rhode Island nursing homes and was signed into law by Gov. McKee, two days after General Assembly passage. The legislation (S 0002A, H 5012Aaa) will establish a minimum standard of 3.58 hours of resident care per day, initially, and 3.81 hours of resident care per day beginning January 1, 2023. The bill also provides funding to raise wages for direct care staff to help recruit and retain a stable and qualified workforce.
With final votes in both chambers, the General Assembly approved The Elder Adult Financial Act sponsored by Sen. Cynthia A. Coyne (D-District 32, Barrington, Bristol and East Providence) and Rep. Joseph J. Solomon, Jr. (D-District 22, Warwick). The legislation requires financial institutions to report suspected financial exploitation of seniors to the Office of Healthy Aging and authorizing them to temporarily hold transactions they suspect as such. The legislation will be sent to the governor for signature. The legislation (S 0264A, H 5642A) would require financial institutions to train employees to recognize indicators of elderly financial exploitation, and on their obligation to properly report it and place a hold on suspicious transactions. The legislation was the result of recommendations made by the Special Task Force to Study Elderly Abuse and Financial Exploitation, a group led by Sen. Coyne that met in 2018 and 2019 to explore the facets of elder abuse and make policy recommendations to address them.
Rep. Gregg Amore (D-District 65, East Providence) and Sen. Valarie J. Lawson’s (D-District 14, East Providence) legislation, The Uniform Control Substance Act, would exclude chronic intractable pain from the definition of “acute pain management” for the purposes of prescribing opioid medication has been signed into law by Gov. McKee. The legislation (H 5247A, S 0384A) calls for new guidelines for treatment of chronic intractable pain based upon the consideration of the individualized needs of patients suffering from it. The legislation acknowledges that every patient and their needs are different, especially those suffering from chronic pain. Chronic intractable pain is defined as pain that is excruciating constant, incurable, and of such severity that it dominates virtually every constant, moment. It also produces mental and physical debilitation and may produce a desire to suicide for the sole purpose of stopping the pain.
The House passed legislation sponsored by Rep. June S. Speakman (D-District 68, Warren, Bristol) to allow visitation for nursing home residents by a designated family member or caregiver during a state of emergency. Under the Rights of Nursing Home Patients legislation, an essential caregiver would be an individual—whether a family member or friend of a resident of a nursing home or long-term care facility – who is designated to provide physical or emotional support to the resident during a declaration of disaster emergency. The legislation (H 5543aa) would require the Department of Health to create rules and regulations providing for the designation of essential caregivers to provide in-person physical or emotional support to a resident of a nursing home or long-term care facility during the period of 15 days after a declaration of disaster emergency and until 60 days after the termination of the declaration. The bill would require DOH to develop rules and regulations on designating an essential caregiver and the criteria to qualify. Those rules would include health and safety regulations as well as requirements allowing an essential caregiver to have regular and sustained in-person visitation and physical access to a resident of the nursing home or long-term care facility. The bill now goes to the Senate, which on June 1st passed companion legislation (S 0006A) sponsored by introduced by Sen. Frank S. Lombardi (D-District 26, Cranston).
As part of its ongoing efforts of addressing the cost of prescription drugs, the RI Senate passed legislation that requires pharmaceutical companies to disclose drug pricing information and legislation would prohibit an annual or lifetime dollar limit on drug benefits. The first legislative proposal (S 0494A), which was introduced by Senate President Dominick J. Ruggerio (D-District 4, North Providence, Providence) would require the pharmaceutical manufacturers disclose to the Office of the Health Insurance Commissioner the wholesale acquisition costs of drugs if this cost is at least $100 for a 30-day supply. It would also require the disclosure of pharmacy benefit management information to include rebates, price protection payments and other payments that are saved by the pharmacy, health plan issuer or enrollees at the point of the drug. The second one, (S 0381A), which was introduced by Senate Majority Leader Michael J. McCaffrey (D-District 29, Warwick), would require that health plans that provide prescription drug coverage not include an annual or lifetime dollar limit on drug benefits. It would also cap out-of-pocket expenses that some consumers would be required to pay for prescription drugs. The measures now move to the House for consideration.
The Senate also approved legislation sponsored by Sen. Melissa A. Murray (D-District 27, Woonsocket, North Smithfield) limiting insured patients’ copays for insulin used to treat diabetes to $40 for a 30-day supply. The legislation (S 0170A), which is part of the Senate’s prescription drug affordability legislative package, would apply to all insurance plans that cover insulin. Under the legislation, insurers would be required to cap the total amount that any covered person is required to pay for covered insulin at $40 for a 30-day supply, regardless of the amount or type of insulin prescribed. It also forbids that coverage from being submit to any deductible. The bill does allow insurers to charge less if they choose. The cost of insulin has risen sharply over the years, and the cost is much higher in the United States than in other countries. Millions of Americans depend on insulin for the management of diabetes. The legislation goes to the lower chamber, where House Speaker Pro Tempore Brian Patrick Kennedy (D-District. 38, Hopkinton, Westerly) is sponsoring a companion bill (H 5196A).
Finally, the passed legislation sponsored by Sen. Valarie J. Larson (D-District 14, East Providence) would increase temporary caregiver benefits for Rhode Islanders. The bill (S 0688) increases temporary caregiver benefits to six weeks in a benefit year starting Jan. 1, 2022, and would increase temporary caregiver benefits to eight weeks in a benefit year beginning Jan. 1, 2023.Rhode Island was the third state in the nation to pass a paid family leave programs when it enacted the Temporary Caregiver Insurance program in 2013. It provides up to four weeks of partial (about 60%) wage replacement for workers who need to take time from their jobs to care for a serious ill family member or to bond with a newborn, adopted or foster child. The worker’s job and seniority are protected while the worker is on leave.An amended companion measure (H 6090A), sponsored by House Majority Whip Katherine S. Kazarian (D-District 63, East Providence) passes the House and now heads to the Senate for consideration.
Deputy House Republican Minority Leader, George Nardone (R-Dist. 28, Coventry, Rep. Michael Chippendale (R-Dist. 40, Coventry, Foster, and Glocester and Rep. Raymond A. Hull (R-District 6, Providence) submitted H 5547 to ensure proper, safe, and personal contact with loved ones in congregate care facilities. The legislation addresses the COVID-19 mandates that denied access to individuals in hospitals, group homes, nursing homes, assisted living facilities and Veterans homes. The purpose of this legislation is to entitle all residents of healthcare facilities and group homes the opportunity to designate a support person for regular, in-person visits. The policy is designed to balance disease transmission protocols with the benefits of having a loved one present during a lockdown. The House Health & Human Services Committee recommended the legislation be held for further study.
Senate Minority Whip Jessica de la Cruz (R-Dist. 23, Burrillville, Glocester, North Smithfield, introduced S 644 to provide medical assistance coverage for medical services provided qualifying eligible recipients for community-based care. The Senate Health & Human Services Committee has also recommended the legislation be held for further study.
Thoughts from the Sidelines at AARP
AARP Rhode Island says they “…are thrilled that the Livable Home Modification Grant Program, which provides matching funds for needed construction to ensure that Rhode Islanders with disabilities can remain safely and comfortably at home, was included in the FY22 budget,” said AARP Rhode Island State Director Catherine Taylor. “That was the highlight of the budget for us. Codifying this program has been a major priority.
“Another important win was enactment of the Elder Adult Financial Exploitation Prevention Act. This law is an important new tool to fight for the one-in-five older Rhode Islanders who is a victim of financial exploitation, with an average loss of $120,000. AARP-RI wrote to Governor McKee urging him to sign this critical legislation and they are delighted that he has done so. This will be a game-changer in the effort to protect the life savings of older Rhode Islanders.
“Now we have our eye on the number of prescription drug bills that we’ve been working hard on, and we’re hopeful they will see passage before the end of the session. At this time, there are four Senate-approved Rx bills that need action in the House, and we are eagerly awaiting House passage of Rep. Brian Patrick Kennedy’s insulin cap bill.
The Legislative session is expected to end by the end of next week. Stay tuned to see what legislative proposals ultimately make it to the Governor’s desk for signature.
UPDATE:
‘According to Maureen Maigret, Vice Chair of Rhode Island’s Long-Term Care Coordinating Council, a former state representative and Director of Rhode Island’s Elderly Affairs, one of the biggest wins for older adults in the budget — the expansion of the Office of Healthy Aging @Home Cost Share program to increase income eligibility from 200% of the federal poverty level to 250% and to include persons under age 65 with Alzheimer’s/dementia. “Over $2Mil in all funds was added to the budget to do this. It was promoted by legislation sponsored by Sen. Walter Felag and Rep. Joseph Solomon. An estimated 500 persons will get subsidized home care and/or adult day services with this expansion. It was a priority of the Aging in Community Subcommittee for several years,” she says.
Maigret also notes that the budget also includes Medicaid rate increases for a number of home and community care providers designed to increase access to these options for persons needing care. “These include assisted living, adult day services, shared living and home care. Importantly, with the cost of so many basic services such as rent and food increasing it raises the amount of money a person on home care can keep to pay for living expenses before they must pay a share of the cost of the services,”
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Herb Weiss 