Seniors Need to Be Wary of Medicare Fraud (USA)

 Seniors Need to Be Wary of Medicare Fraud
Bernard A. Krooks, Contributor

In previous entries, we’ve discussed different types of financial elder abuse. One thing is certain, Medicare abuse and fraud is rising.  Experts estimate that in 2010, Medicare and Medicaid together made $65 billion in improper payments, and that number rose to $98 billion in 2011. [1] As thieves become more sophisticated, seniors and caregivers must become more vigilant – as Medicare abuse and fraud can affect a loved one’s health and healthcare programs. Here’s a quick guide to Medicare fraud and a few tips to protect yourself and your loved ones:

Medicare fraud is defined as any individual or company searching for Medicare reimbursement payments under false pretenses. [2]
There are a few common types of Medicare fraud that include:
•    Identity Theft: When a medical professional steals patient information to use to over-bill Medicare.
•    Equipment Substitution: An order for medical equipment may be intercepted, with Medicare being billed for newer or more expensive equipment and the patient being provided with cheap or used equipment.
•    Phantom Billing: A doctor’s office may bill for services never performed.
•    Upcoding: A medical provider may submit bills to Medicare for a more expensive service than the one actually performed.
•     Unnecessary Procedures: A doctor may perform procedures that are not medically necessary in order to bill Medicare for the cost.
•    Generic Drugs: Medicare is often billed for name brand medications when generic drugs were actually provided to the patient.
Medicare fraud doesn’t just cost the federal government.  It often results in substandard medical treatment for the patient, and the additional costs can mean that the patient’s Medicare allotment is used up due to fraudulent billing. Fraud costs also increase health care costs and can eventually lead to higher taxes.
Here are a few things you can do to protect yourself or a loved one from Medicare fraud:
•    Review your claims for mistakes or concerns:
•    Keep a record of the dates of your doctors’ appointments and save your receipts and statements that you receive from providers to check for errors.
•     Compare your records with the Medicare processed records to ensure you were not billed for any services you did not receive. You can review your Medicare claims by:
•    visiting www.mymedicare.gov (claims are normally available within 24 hours after processing)
•    calling 1-800-Medicare (1-800-633-4227) or
•    looking at your Medicare Summary Notice (MSN)
•    If you notice an incorrect charge on your bill, call your doctor or health care provider to give you more information to better understand the billing issue—it is possible there was a billing error.
•    Make sure that the information below is readily accessible before contacting your doctor, health care provider, or Medicare:
•    Your name and Medicare number
•    The date of your Medicare Summary Notice (MSN)
•    The provider’s name & any identifying number;
•    The service or item in question;
•    The date the service/item was received;
•    The payment amount approved/paid for by Medicare;
•    The reason you think Medicare should not have paid;
•    Any information providing evidence to show why Medicare should not have paid for the service/item in question.

If you think you or your loved one may have been a victim of Medicare fraud, help is available.  The Senior Medicare Patrol is a federally-funded resource to help seniors combat Medicare abuse.  To contact the New York Senior Medicare Patrol, call the 24-hour hotline at 1-877-678-4697 or visit http://www.aging.ny.gov/ResourceGuide/HealthInsurance.cfm. For more information about our elder law services, visit www.elderlawnewyork.com.

SOURCE:      The New York Times
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