Scrooge and Marley Respectfully Suggest…

If any firm (or its partners) represents an extreme conservative agenda, it is surely 19th century London’s Scrooge & Marley, that bastion of penny-pinching, debt collecting industrial capitalism.  That the counting house is Charles Dickens’ creation and fictional matters not at all.  Imagine if those two were running things today?  Would any social benefits programs survive at all?  Surely not.

We are lucky, then, that they do not control Medicare, the social insurance program that covers those over 65 and individuals under 65 in special circumstances.  Without this health insurance program, nearly all of our aging parents and relatives, or those disabled and permanently incapacitated, would be without access to major medical coverage and many other health and preventive services.   But Mr. Scrooge and Mr. Marley most certainly would approve of Medicare’s diligent efforts to prevent fraud and recover the millions of dollars per year now lost to false claims.

While it is true that no one knows exactly how much this fraud costs American taxpayers each year, at least $2.3 billion in false claims have been billed since 2007.  Fraud results in higher health care costs for everyone.  The Medicare Fraud Strike Force was formed several years ago by the Department of Justice and Health and Human Services to address the problem and has some suggestions for beneficiaries.

First and foremost, be sure your parents, relatives, friends and loved ones who have Medicare benefits carefully review each and every Medicare statement they receive to be sure Medicare is not being billed for items and services that they, the patients,  did not receive.  Review the statements for them if they find the whole thing too much –  and it is tedious, there’s no way around it.  Once upon a time, we were so happy we personally weren’t being billed, we didn’t care about the rest as long as we weren’t writing the checks.  Those days are gone.  Again, fraud hurts us all.   Unless we secure the borders, so to speak, we will lose the kingdom.

Here are some examples of possible Medicare fraud:

  • A supplier bills Medicare for equipment never received.
  • A healthcare provider bills Medicare for services you – or your parents or relatives – never received.
  • Someone uses another member’s Medicare card to obtain supplies, equipment or medical treatment or care.
  • Someone bills Medicare for home medical equipment after it has been returned.
  • A company offers a Medicare drug plan that has not been approved by Medicare.
  • A company or sales agent uses false information to mislead you into joining a Medicare plan.

Be very wary if any provider tells you that:

  • All sorts of neat equipment, like wheelchairs or seat lifts, is free.
  • They have special ways to get Medicare to pay for an item or service.
  • The more tests they offer, the cheaper they are.Be

Be extremely suspicious of any providers who:

  • Advertise free consultations to people with Medicare.
  • Claim to represent Medicare or any branch of the federal government.
  • Do not charge co-payments or coinsurance without first confirming your ability to pay.
  • Use pressure, threats or scare tactics to sell expensive medical services, procedures or diagnostic tests.
  • Bill Medicare or any other insurer for services or items you did not get.
  • Bill Medicare for services or equipment that are different from what you received.
  • Bill Medicare for home use medical supplies or equipment after you’ve returned it.
  • Offer non-medical transportation or housekeeping as Medicare-approved services.
  • Put a wrong diagnosis on a claim so that Medicare will pay.
  • Bill home health services for people who are not confined to their homes.
  • Encourage you to contact your doctor and ask for a service or supplies you do not need.
  • Offer you payments or gifts to go to clinics or offices.
  • Offer a free power wheelchair, scooter or any other equipment.
  • Want you to use their doctors.
  • Charge co-payments on clinical lab tests and on Medicare-covered preventive services (such as PAP tests, PSA tests, flu or pneumonia shots)
  • Offer to waive Medicare Part B co-insurance or deductible.
  • Alter claims to receive higher payment.
  • Charge a restocking fee, or pick-up fee, for equipment or supplies you are returning.
  • Call you when you did not give them your phone number.
This is a hectic, even frantic time of year.  Medicare Open Enrollment ends December 7th.  All sorts of insurance agents and providers are anxious to finish the year with strong sales – everyone feels the pressure.  Many of these salesmen are fine, and just as many are not.  The holidays bring us together and help us keep track of the family, the whole family, especially the ones we don’t see the rest of the year.  So keep an eye on those older relatives and friends.  Be sure they aren’t isolated or overwhelmed, or just plain alone too much, making them easy targets for con artists and insurance scammers.  We want a lovely, happy holiday season, as in the closing pages of A Christmas Carol, not a miserable, lonely one, as in the cautionary tale’s opening pages.  Ask the Cratchits!
Next up, tips for Medicare fraud prevention.  Have a great weekend!

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