Senior Voice -

By Teresa Ambord
Senior Wire 

You might be participating in Medicare fraud

 


If you watch much TV you’ve probably heard the ads for free or nearly free medical items, possibly a knee brace, back brace, or other device. “If you qualify for Medicare, then you qualify to get these items or services – all you have to do is ask. You don’t even have to need the items.”

Why would the manufacturers do this? Because to get your freebies, you have to give them your valuable Medicare ID number, or other insurance ID, so they bill for the items. It is a way to drum up business, but the fact is, you may not receive the items at all. And even if you do, your medical ID may now be used in a vast fraud scheme that could go way beyond the cost of a back brace.

Generally, a doctor’s signature is required for medical devices or tests to be paid for by any medical insurance. Doctors report that they are suddenly flooded with forms to sign for devices and tests that the doctors did not order and that are not necessary or even helpful. It’s hard to fault a patient who is offered something for free. Who doesn’t like free? But doctors generally recognize the fraud and refuse to cooperate.

No problem. Scam artists don’t mind faking a doctor’s signature. Or they find a corrupt doctor who will take a bribe.

Another Medicare fraud: rolling labs

The rolling lab scam usually sets up in a senior center, a retirement home, a shopping mall, a health club, or other location, maybe even a church. They offer free or low cost tests which may be totally unnecessary and possibly fake. Again, if you have Medicare or other insurance, you provide them what they want and they give you free or low-cost tests. That’s what they say. Once they have your name, they may bill for services that were never performed. You may not know it, but you’ve participated in a fraud.

Here’s a real life example of a rolling lab scam, right off the FBI website. In April 2015, a U.S. District judge in southern California sentenced a man – Gevorg Kupelian — to 30 months in prison, and a fine of nearly $1 million for setting up a fake clinic aimed at seniors.

He called it the El Centro Clinic, in El Centro, California. It was as simple as finding an unscrupulous doctor to be the “doctor of record,” and a physician’s assistant who actually saw patients. Then he hired “cappers,” or people he sent out to find seniors and convince them to go to the clinic.

In exchange for their Medicare numbers, seniors were given a buffet lunch and/or a free pair of shoes.

At the clinic, the seniors went through a battery of tests that bore little or no connection to their medical needs, and were not necessarily supervised by a physician. In some cases, no tests were performed at all, yet Medicare was billed.

U.S. Attorney Laura Duffy said, “This defendant had no regard for the medical needs or well-being of patients. He exploited vulnerable seniors — even giving them unnecessary tests without a doctor’s approval — in order to get rich quick on the backs of taxpayers.”

How common is this? It’s a growing problem. As noted earlier, Medicare scammers have prospered enough that some may be advertising to bring in new victims to inadvertently help with Medicare fraud. And their fraud is endangering the future of Medicare.

FBI Special Agent in Charge, Eric S. Birnbaum said in a press release related to the case above, “Medicare fraud schemes such as this undermine our health care system and can jeopardize a patient’s health. Today’s sentencing reaffirms the FBI’s commitment to aggressively pursue those who seek to become unjustly enriched by stealing money from the pockets of American taxpayers.”

How can you avoid this kind of fraud?

Don’t accept services and/or equipment that a doctor did not order for you. Check with Medicare or an insurer to learn if a service or piece of equipment will be covered. If telemarketers or door-to-door representatives offer tests, services or equipment, decline. If you give them your name and your insurance card, there’s no telling what will get billed in your name.

Tips from the FBI for avoiding health care fraud or health insurance fraud:

• Never sign blank insurance claim forms.

• Never give blanket authorization to a medical provider to bill for services rendered.

• Ask your medical providers what they will charge and what you will be expected to pay out-of-pocket.

• Carefully review your insurer’s explanation of the benefits statement. Call your insurer and provider if you have questions.

• Do not do business with door-to-door or telephone salespeople who tell you that services of medical equipment are free.

• Give your insurance/Medicare identification only to those who have provided you with medical services.

• Keep accurate records of all health care appointments.

Do you suspect fraud?

Here’s what Medicare advises:

• You may have gotten a bill or report of charges that looks wrong to you. According to Medicare, if you know the provider, call their office to talk about it. It could be an innocent billing error.

• If you’ve contacted the provider and you suspect that Medicare is being charged for a service or supply you didn’t get, or you don’t know the provider on the claim, call 1-800-MEDICARE.

Alaska’s Senior Medicare Patrol (SMP) is housed in the Medicare Information Office. To report concerns about fraud or abuse, call 907-269-3680 or contact nila.morgan@alaska.gov.

 
 

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