Medical Providers and Patients Team Up to Prevent Medicare Fraud

While this post is written mainly from the consumer’s point of view, it shows the need as well as the effort that is underway to prevent Medicare fraud. It requires a joint effort the part of both the patient and the medical provider. Knowing that the patients, themselves, are getting involved in a very grassroots way demonstrates that medical providers are not alone in this fight against fraud. Hopefully as knowledge of this movement grows, those who are involved with fraud will realize that patients are not easy prey.

The U.S. Department of Health and Human Services is not sitting still and letting those involved in collecting money for fraudulent services get by without trying their best to put a stop to it. Last year, for every dollar that was spent on these fraudulent activities, the government recovered $8.10. That may not seem like much, but it will grow as the government moves into a high-level of pursuit of these funds.

Just look at who is becoming involved in a most positive way. There is the SMP also known as the Senior Medicare Patrol. These are highly trained volunteers who give of their time and experience to show the average senior how to recognize and report fraud. SMPs have taught over 11,100 groups of beneficiaries and 4.3 million Medicare recipients.  This training has resulted in over 300,000 complaints for investigation that generated over $106 million recovered by both Medicare and Medicaid.

The STOP Medicare site has a listing of the common scams. Medical providers can help patients become more aware of some of the common items on the list such as:

  • Beware of those asking for your Medicare number in exchange for free equipment or services
  • Try to convince you that tests become cheaper as more are provided
  • Call or visit, use door to door selling techniques
  • Bill Medicare for services you have not received… so read each and every statement!
  • Bill Medicare for equipment when you do not qualify, hoping it will go through unnoticed. Again, read that statement carefully.

The crime takes many forms. Identity thieves may rent an apartment, obtain a credit card, or establish a telephone account in your name. You may not find out about the theft until you review your credit report or a credit card statement and notice charges you didn’t make—or until you’re contacted by a debt collector.

The Affordable Care Act is going through many changes and trials, but on its list they have put health care fraud, waste and abuse at the top. Like the Senior Medicare Patrol, we can all do our part to help patients avoid falling into the ‘trap of fraud.’

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