How Can You Help Prevent Future Medicare Fraud?
Medicare fraud is a general term that refers to an individual or corporation that seeks to collect health care reimbursement under false pretenses. This can occur when Medicare is billed for services or supplies you never got. Medicare fraud is different than abuse: Medicare abuse happens when doctors or suppliers don't follow good medical practices, which leads to unnecessary costs to Medicare, improper payment, or services that aren't medically necessary. A complaint about the quality of care you got from a doctor, hospital, or other provider or facility isn't considered fraud or abuse.
The Centers for Medicare and Medicaid Services estimates that Medicare fraud costs taxpayers tens of billions of dollars every year.
Officials reported on October 2, 1012 that ninety-one people including doctors, nurses and other medical professionals were charged criminally after an investigation of Medicare fraud that involved $430 million in false billing in seven cities. The accusations include billing the government for unnecessary ambulance rides in California, writing prescriptions patients in Dallas who did not qualify for them and paying kickbacks like food and cigarettes to patients in Houston if they attended programs for which a hospital could bill. It was the government’s second big raid in recent months after a similar investigation in May involving $452 million in alleged Medicare fraud.
Another case highlights of victimization of Medicare recipients in certain schemes to defraud Medicare. Jerry Gilman, a 68 -year-old Vietnam veteran from California, has a medical condition that often makes him dizzy and in danger of falling. His daughter, Deborah, and his doctor arranged for him to have a Hoveround motorized chair to help him with his mobility. The chair that arrived, however, was not the chair that Mr. Gilman ordered. It was smaller, flimsier, and made by an entirely different manufacturer. The daughter called Medicare and Hoveround. Both stated they couldn’t do anything as Medicare had already processed the payment for the chair. After a Medicare anti-fraud program became in involved it was learned that someone had intercepted Mr. Gilman’s order at his doctor’s office and replaced it with the less sturdy chair. Eventually, Medicare was able to correct the problem and get Mr. Gilman the correct chair.
Medicare recipient Chuck Johnson of Montana received a telemarketing call offering him diabetic testing supplies that he didn’t want or need. Even though he was exceedingly clear with the caller that he did not want anything, charges for those supplies showed up on his Medicare statement anyway. Mr. Johnson got in touch with a Medicare anti-fraud and senior advocacy program for help to see if they could help fix the problem. Not only did his call mean that Medicare recovered money, it also opened up a broader investigation into the national organization soliciting Mr. Johnson.
How should Medicare recipients detect fraud? First, always review your Medicare Summary Notice or Part D EOB. Look for charges for something you didn’t get, that you were billed twice for or they reflect services that were not ordered by you or your doctor.
What do you do if you feel scammed? If you have detected suspicious or erroneous activity on your Medicare Summary Notice or Part D Explanation of Benefits (EOB), you should contact your provider or plan. If you are not comfortable calling your provider or plan or you are not satisfied with the response you get, there are agencies designed to combat this kind of fraud. In Northern California the Health Insurance Counseling & Advocacy Program (HICAP) is valuable cost-free asset to available to seniors. HICAP provides one-on-one counseling service for regarding Medicare related issues - including when there is evidence of Medicare fraud.
In short, awareness of exactly what your physician has prescribed and paying attention to your Medicare Summaries and EOBs for inconsistencies may prevent future Medicare Fraud.
About the Author: Margy Wenham has been working as an independent insurance agent for over twenty (20) years in Redding, California. She represents most major insurance carriers and can be reached by calling 530.221.0955, emailing her at MargyWenhamInsurance@gmail.com or by going to her website located at www.MedicareSupplementByMargy.com.
The Centers for Medicare and Medicaid Services estimates that Medicare fraud costs taxpayers tens of billions of dollars every year.
Officials reported on October 2, 1012 that ninety-one people including doctors, nurses and other medical professionals were charged criminally after an investigation of Medicare fraud that involved $430 million in false billing in seven cities. The accusations include billing the government for unnecessary ambulance rides in California, writing prescriptions patients in Dallas who did not qualify for them and paying kickbacks like food and cigarettes to patients in Houston if they attended programs for which a hospital could bill. It was the government’s second big raid in recent months after a similar investigation in May involving $452 million in alleged Medicare fraud.
Another case highlights of victimization of Medicare recipients in certain schemes to defraud Medicare. Jerry Gilman, a 68 -year-old Vietnam veteran from California, has a medical condition that often makes him dizzy and in danger of falling. His daughter, Deborah, and his doctor arranged for him to have a Hoveround motorized chair to help him with his mobility. The chair that arrived, however, was not the chair that Mr. Gilman ordered. It was smaller, flimsier, and made by an entirely different manufacturer. The daughter called Medicare and Hoveround. Both stated they couldn’t do anything as Medicare had already processed the payment for the chair. After a Medicare anti-fraud program became in involved it was learned that someone had intercepted Mr. Gilman’s order at his doctor’s office and replaced it with the less sturdy chair. Eventually, Medicare was able to correct the problem and get Mr. Gilman the correct chair.
Medicare recipient Chuck Johnson of Montana received a telemarketing call offering him diabetic testing supplies that he didn’t want or need. Even though he was exceedingly clear with the caller that he did not want anything, charges for those supplies showed up on his Medicare statement anyway. Mr. Johnson got in touch with a Medicare anti-fraud and senior advocacy program for help to see if they could help fix the problem. Not only did his call mean that Medicare recovered money, it also opened up a broader investigation into the national organization soliciting Mr. Johnson.
How should Medicare recipients detect fraud? First, always review your Medicare Summary Notice or Part D EOB. Look for charges for something you didn’t get, that you were billed twice for or they reflect services that were not ordered by you or your doctor.
What do you do if you feel scammed? If you have detected suspicious or erroneous activity on your Medicare Summary Notice or Part D Explanation of Benefits (EOB), you should contact your provider or plan. If you are not comfortable calling your provider or plan or you are not satisfied with the response you get, there are agencies designed to combat this kind of fraud. In Northern California the Health Insurance Counseling & Advocacy Program (HICAP) is valuable cost-free asset to available to seniors. HICAP provides one-on-one counseling service for regarding Medicare related issues - including when there is evidence of Medicare fraud.
In short, awareness of exactly what your physician has prescribed and paying attention to your Medicare Summaries and EOBs for inconsistencies may prevent future Medicare Fraud.
About the Author: Margy Wenham has been working as an independent insurance agent for over twenty (20) years in Redding, California. She represents most major insurance carriers and can be reached by calling 530.221.0955, emailing her at MargyWenhamInsurance@gmail.com or by going to her website located at www.MedicareSupplementByMargy.com.
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