At a recent "hunger summit" meeting in Dallas, an offhand remark about the $90 billion each year in Medicare fraud was greeted with disbelief from listeners. While that estimate may be on the high end, Medicare fraud is no small problem in senior health care, ranking right up there with the dual concerns of hunger and proper nutrition among the nation's aging population.
According to a recent article in the Los Angeles Times, the government confirms that fraud involving various Medicare systems accounts for between $60-90 billion annually. In California, according to investigators, about 20% of the fraudulent claims involve durable medical equipment such as knee and back braces, mobility aids and other supplies that may be offered "free of charge" with no professional evaluation.
What's the Catch?
You've probably seen ads or heard the commercials on television. Whenever something is offered at no charge, say the experts, warning lights should flash in your brain. Such offers always come at a cost, whether the fees are paid by individuals, the medical community or shifted to taxpayers.
Many types of insurance fraud exist: overbilling, "errors" that include duplication of services, incorrect dates, charging for services not performed, and other such "undetected bookkeeping mistakes." Blatant examples of duping the system are relatively easy to spot, but others are hidden and more insidious.
Medical identity theft, including the fraudulent use of social security numbers, is a growing problem, according to the Coalition Against Insurance Fraud in Washington, D.C. Medicare and Medicaid have been designated "high risk" programs by the group because of their size and complexity.
Coalition Communications Director James Quiggle notes that cold calling to sell medical equipment and services is almost always a violation of law. Even though the equipment and services might not cause direct harm, they do no good, are not medically necessary, and might raise false hopes. "Don't engage these people," says Quiggle. "They are professional hucksters, and they're good at separating people from their money."
Protect Against Fraud
When you’re a caregiver, protecting a parent from Medicare fraud can be as easy as maintaining an ongoing and honest relationship with mom or dad’s primary physician. Discuss any treatment options and medically necessary equipment thoroughly. Arm yourself with reliable, factual information. By knowing the facts about a health condition, and partnering with a primary doctor to assure the best possible care for a senior loved one, you are in a better position to resist false claims.
If you suspect that any claim for treatment, medication, services, supplies or equipment is less than legitimate, ask questions. Any reputable supplier of medical equipment and supplies—walking aids, testing and monitoring devices, durable or reusable gear—will be happy to supply backup information and to discuss actual costs with you. And, of course, if you are approach be a salesman with a fishy deal, you should always report your suspicions.
Be proactive about rooting out potential fraud:
- Be wary of unsolicited phone calls or a knock at your door from anyone claiming to be associated in any way with government or Medicare services.
- Never give out personal information, including your Medicare account number, to a casual caller.
- Monitor your quarterly Medicare statements; check with your parent’s if you see unusual billings, or call the Medicare claims number for clarification.
- MyMedicare.gov is a personalized, online portal that not only summarizes all your personal data, but provides valuable additional information. It is a valuable "one stop shop" for tons of important information. Learn to use it.
- Report anything suspicious to local, state and federal authorities.
While it may be the same old story, the ending can be different, according to those who are serious about fighting Medicare fraud. Allowing it to continue is too high a price to pay, not only in terms of dollars and cents, but also in terms of the quality of care for your senior loved ones.