Fraud in Our Healthcare System: How to protect seniors against fraud

How often have you read about a local company committing fraud against the Federal Government, generally the Medicare system? Twice, maybe three times this week alone? If you read as much news as I do in print or on the Web, or if you watch the news shows on your television, arrests are occurring every day for fraud. FYI: fraud is the intentional falsification of information with the purpose to deceive.

Let’s take a minute to delve into the world of the Medicare system. You may ask why would this concern Visiting Angels, a company in the home care system, not the healthcare arena.

All the funding mechanisms for our national medical health insurance programs: Medicare, Medicaid, and Tri-Care are inextricably linked through our legislative efforts. Whether we like it or not, when one of these three groups experiences a problem, it will eventually effect the others through some form of legislation -- whether it be reduced funding, increased control and monitoring, or even elimination of part of a program. It is up to all of us to monitor what occurs in the public with a watchful eye towards any unusual practices so that the general public, and in particular our clients/care recipients, are not being ripped-off by fraudulent companies posing as legitimate government licensed providers.

The official government website for Medicare, www.Medicare.gov, has listed several points to consider when identifying and reporting fraud. Here are some tips that may help to reduce potential Medicare fraud:

• If you are uncertain about your statement, contact your service provider first.
• If you notice an error on your Medical Summary Notice (MSN), contact your provider. Legitimate errors do occur and can be easily corrected.
• Check the dates of service provision for their accuracy.
• Did you receive double billing? There may be reasons you receive two bills, i.e., one provider offers the service and another simply reads the x-rays, MRI, or other tests. Check it out just to be sure.
• Is the address of the provider different than the office you received service?
• Do you recognize the name of the doctor who provided the services?

Some of these can be clerical mistakes and easily explained, yet at times, some of the points sited above may actually be a form of provider fraud. A simple phone call may eliminate your concerns and prevent this fraud.

From the same government website, here are some tips for reducing the potential fraud cases that are so rampant in our system:

1. Never give your Medicare number to anyone, except your doctor or other Medicare provider.
2. Don’t allow anyone, except your medical provider, to review your medical records or recommended services.
3. Don’t contact your doctor to request a service that you do not need.
4. Do be cautious when you are offered free testing or screening in exchange for your Medicare card number.
5. Do be cautious of any provider who states he or she has been endorsed by the Federal Government or by Medicare.
6. Do avoid a provider of healthcare items or services who tell you that the item or service is not usually covered, but they know how to bill Medicare to get it paid.
7. Do use a calendar to track your appointments, admissions, discharge dates, and what tests or x-rays you get then compare this with the MSN.

In a report by MSNBC’s Mark Potter (www.msnbc.com, Dec. 11, 2007), it was estimated that Medicare fraud can account for nearly “$60 billion dollars a year – a staggering cost borne by American taxpayers.” It is clear that our government, which instituted our medical insurance programs, is unable to enforce the laws which are on the books to protect the very people who would most benefit from these programs. What’s left to do?

It is up to us, the general public, to scrutinize our bills and review service recommendations, billing inconsistencies, unusual office locations, “too good to be true” offers, etc. If we all regularly question what is happening with our service providers, we should be able to greatly reduce fraud in our medical insurance programs.

As for me, I’m all for making sure the amount of taxes I pay goes to legitimate programs, and that my tax dollars don’t end up in the hands of some rip-off artist.