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Silver Alert: Fine Print Ahead

Where there’s money, there’s temptation.  Where there’s lots of money, there’s lots of temptation.  Most health care professionals who work with Medicare – our doctors and their staffs, the providers, and the suppliers and private contractors and companies who serve the health care community – are honest.  But most is not all.  Fraud costs Medicare (which means us) millions of dollars every year.  Just last September, the Medicare Fraud Strike Force charged 91 individuals for some $295 million in false billing – and that was only one investigation among dozens.

In this particular case, the task force found that doctors, nurses, health care company owners, medical professionals and others participated in an array of fraudulent schemes;  an FBI assistant director said those charged in the scams had been treating the Medicare program ‘like a personal piggy bank’.  Medicare was billed for treatments and services  that were never received or were totally unnecessary.  Private beneficiary information – that’s confidential patient history – was seriously misused and compromised.  The whole situation is deeply disturbing.  Who wants to find out that the great doctor who is taking such good care of mom and dad is actually a nest-feathering crook?

Now, here’s the thing.  We can do something about this.  Seriously. We can help prevent a lot of this theft and violation of trust and patient privacy.  Taking a stand against the fraud is not dangerous, nor is it glamorous or fun, particularly, but it will make a real difference.  It’s about reading that fine print, line by line.  No one likes this chore,  to be sure – thieves count on it –  but it has to be done.  The devil’s in the details, right?  And the details are in the statements.

It is very important to help our aging parents, loved ones and friends keep scrupulous track of all their Medicare (and related) statements.  And while we could remind our older family members to keep their wits about them generally, especially when it comes to sales agents and marketers, we must never scold or criticize.   Nor blame the victims.  It is almost impossible to cope with the paperwork blizzard a claim generates, along conflicting prescription records and confusing medical invoices, when we don’t feel well or are frightened about our health.  Remember that.  So don’t wait for an invitation.  Step in, as tactfully as the situation might warrant, and help.

Here are some other good fraud prevention reminders from Medicare:

  • Never, ever give anyone your Medicare ID number, except your doctor or other known and trusted Medicare provider.
  • Never allow anyone, except your medical providers, to review your medical records or recommend services.
  • Do not accept medical supplies from door-to-door salesmen.
  • Do not ask a doctor to make false entries on bills, records or prescriptions in order to get Medicare to pay.
  • Be very careful about accepting Medicare services that are represented as ‘free’.
  • Free testing?  Free screening?  Be careful if this is done in exchange for your Medicare card number.
  • Be very wary of any provider who states he or she is endorsed by the federal government or by Medicare.
  • Stay clear of any providers of healthcare supplies or other goods and services who claim that while an item or service is not usually covered, they have a way to bill Medicare to get it paid.
  • Use a diary, day planner or calendar to track all appointments, admission and discharge dates, and what tests, x-rays, scans or other procedures have been done – and then compare these records against the Medicare Summary Notices (MSNs) received later.

If  you or a loved one suspect Medicare fraud, gather the following information and then contact the Office of the Inspector General:

  • The provider’s name and any identifying number you might have.
  • The item or service you are questioning.
  • The date on which the item, service or treatment was supposedly furnished.
  • The amount approved and paid by Medicare.
  • The date of the Medicare Summary Notice (MSN).
  • The name and Medicare number of the person who is said to have received this item or service.
  • The reason you believe Medicare should not have paid.
  • Any other supporting information you may have to show that Medicare should not have paid for the item or service.
  • Call in the suspected fraud to the Inspector General at 1-800-447-8477.
  • Email your report to HHSTips@iog.hhs.gov.
  • Go online to: Stop Medicare Fraud.

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