Last year, the federal budget took a hit of $60 billion due to Medicare and Medicaid fraud and abuse, according to the U.S. Departments of Justice and Health and Human Services. This month, federal officials charged more than 100 health-care providers with Medicare fraud as a result of unrelated scams in seven major cities. Federal raids uncovered $452 million worth of false Medicare claims for care that was never provided, making it the biggest single Medicare bust in history.
A federal program called Senior Medicare Patrol is using senior-citizen volunteers to educate other seniors about Medicare fraud, including how to detect it and avoid becoming a target. Its mission is to encourage seniors to protect important personal information, look for fraudulent activity, and report wrongdoing. In Pennsylvania, the patrol is administered by the Philadelphia-based Center for Advocacy of the Rights and Interests of the Elderly.
So what does fraud look like? You receive a phone call out of the blue from someone asking personal questions for reasons you're not sure are legitimate. Or a company representative shows up at your home and tells you that you can qualify for an arthritis kit if you hand over your Medicare number. Or you get a postcard from a private organization declaring that your Medicare benefits have been decreased and encouraging you to return a request for free information about new deductibles and co-pays.
These are just a few of the ploys that often result in transmission of personal information and, eventually, Medicare fraud. There are several ways that personal information can be used to commit Medicare fraud. A company may bill Medicare for equipment or services that were never provided, or it may bill for the same procedure twice. Care providers may provide 10 minutes of service but bill for an hour, or they may send a client more supplies than necessary and bill Medicare for all of them.
Take the recent indictment of five nurses from Home Care Hospice in Philadelphia, who are charged with $9.3 million in Medicare fraud. They are accused of falsifying documents to charge ineligible patients for expensive hospice care that was never provided and billing the government for it. The scheme alleged is simple, but the consequences for the state and its taxpayers are significant.
The bottom line is that Medicare and taxpayers are frequently charged for products and services that were never delivered. Stuck in the middle are elderly people who are intimidated into giving up personal information or enticed by deals that are too good to be true.
If you or a loved one is covered by Medicare or Medicaid, you can prevent fraud by safeguarding personal beneficiary information just as you would your credit card information. A stolen Medicare number is like a stolen credit card number, except taxpayers are stuck with the fraudulent charges.
Beneficiaries also should review their medical bills carefully for any errors or inconsistencies. If you think you might be a victim of health-care fraud, or if you think you may have been targeted by an unscrupulous salesman or telemarketer, you should report it to the Senior Medical Patrol immediately.
Rebecca Nurick is coordinator of the Pennsylvania Senior Medical Patrol at the Center for Advocacy of the Rights and Interests of the Elderly, which can be reached at 1-800-356-3606.