Medicare is one of the best programs that the United States has come up with. It ensures that most people over sixty-five can obtain essential health services without going bankrupt.
Unfortunately, Medicare is also susceptible to con artists who use stolen or misused information to make a quick buck. To protect your senior--and the Medicare system--caregivers will want to be informed about the most common forms of Medicare fraud.
Billing for services never received
This type of fraud generally occurs when a scammer obtains your senior’s Medicare number. Using that number, the fraudster can then bill Medicare for services that the patient never receives.
Possibly the most famous instance of Medicare fraud was the case of June Smith, a seventy-two year old woman who discovered that her Medicare account had been billed for a pregnancy test and a prostate test.
When this kind of fraud occurs, it’s likely that no medical service of any kind was received by anyone. Instead, fraudsters set up fake medical establishments and bill Medicare with stolen identification.
Medicare employees are surprisingly reluctant to identify this kind of theft. Even after reporting fraud to Medicare, June Smith, discovered that several more bogus bills were paid out. Apparently, no one at Medicare took the time to notice that she was a woman or that she had obtained a hysterectomy before paying the fraudulent claims.
Billing for Services Different From What Was Received
Some doctor’s offices are more scrupulous than others. Bill padding occurs when a medical practice treats your senior for a health issue, then bills Medicare for treatments that were not received.
For example, if your senior goes to the doctor for a broken shoulder and the x-ray shows a clean break, and the doctor says, “time will heal,” the senior’s Medicare account should only be charged for the x-ray and diagnosis. If a medical clinic charges for setting the bone and applying a cast, that would be fraud.
Telling a Senior That Medicare Will Pay For a Service That Is Not Covered by Medicare
Unfortunately, medical practices often tell a senior or other patient that their treatment will be covered by insurance. Then a month or so later, the patient gets a huge surprise bill.
This is potentially the most damaging form of fraud to the patient herself, because she may now have to pay a bill she did not plan for. It can be very difficult or impossible to prove that a doctor said the service was covered. And, in some cases, the doctor himself was mistaken about what services are covered by Medicare. In any event, the patient is generally responsible for the bill.
How to Prevent Medicare Fraud
Seniors often need advocates when they go to a doctor’s office or clinic. The advocate can be a caregiver or a home care worker. The advocate’s job is to ask questions, check information against the Medicare handbook, and make sure that the senior’s Medicare card doesn’t get into the wrong hands.
In conclusion, Medicare is a huge help to most seniors. But, like many systems, it is susceptible to abuse and corruption. Caregivers need to be aware of the most common Medicare scams, and protect their seniors.
Sources
https://www.upi.com/Top_News/US/2010/06/01/Woman-72-charged-for-pregnancy-test/77421275407669/
https://www.nydailynews.com/news/medicare-scam-elderly-woman-billed-pregnancy-test-semen-analysis-prostate-exams-article-1.180333
https://www.medicareinteractive.org/get-answers/medicare-fraud-and-abuse/medicare-fraud-and-abuse-overview/fraud-defined
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