Billion Dollar Waste via Medicare Fraud in this month’s AARP Bulletin

[VintageBetter]

I could not find the story on their site. It is on the AARP Bulletin site which you can only access if you are a member and log in. But the gist of the story is cold callers called patients to sell them joint braces, like for knees, wrists and elbows. They mailed them to patients but their doctors never ordered them and either the sellers stole the doctor’s Medicare I.D. numbers and billed that way, or there were fraud doctors who signed on, either knowingly or unknowingly, for the fake program.

As I have posted before, when someone calls me wanting to sell me anything related to my medical plan, my first reaction is “NO”. If did not initiate the call, I’m going to assume you could be crooked.

Anyway - by the time the fraud was discovered, Medicare spent $1 billion on braces that may or may not have been of any help at all.

HOW CAN YOU AND I REPORT MEDICARE FRAUD?

Here’s some more Medicare Fraud:
https://www.aarp.org/money/scams-fraud/info-2023/most-common-medicare-scams.html

https://www.aarp.org/money/scams-fraud/info-2023/dolson-avenue-medical.html

You can volunteer to be a Medicare Fraud Patrol member: https://www.aarp.org/health/medicar...-to-volunteer-for-senior-medicare-patrol.html

Or call 1-800-MEDICARE (1-800-633-4227), or submit a complaint online: https://oig.hhs.gov/fraud/report-fraud/

 

[Born_To_Lose]

Always check your Medicare statement that you receive each month. If anything looks suspicious or unreal or any service or drug that you did not receive, but is listed call Medicare at once. Call Medicare at 800-633-4227. TTY users may call 1-877-486-2048. In my number of years that I worked for the government, I received over 2000 cases that landed on my desk to prosecute. I will admit that this is a joke. A prosecutor cannot begin to prosecute a single case until its been investigated and proof can be obtained of any fraud. Your word or my word means very little before a judge.

 

[TennVet]

We found that our Medicare Supplement insurance had paid some large claims to a fictitious provider. I say fictitious knowing that some sort of information was provided to get claims paid. Fact is it named a provider that supposedly did business in the town where we live, which is a rural community with only a small handful of businesses. It was very easy to verify to our Insuror that it was not a claim of ours. I've got to believe there is a form of identity theft involved, but we haven't found any other trace of it impacting us.

 

[Jules]

I’d already deleted this email, so searched for it after reading this post.

You’re feeling sick, so you go to the doctor. Bad news: You need surgery. Worse news: Your insurance won’t cover it. They say you’ve already had two surgeries this year.

The catch? You haven’t. This is the nasty reality of medical fraud.

I’ve been beating this drum a lot lately and for good reason. This year’s ransomware attack on Change Healthcare put 50% of all U.S. medical claims at risk. Think about that — you’re in a room with 20 people and 10 will likely get hit by medical ID theft.

Here’s what could happen if you’re one of the Americans whose medical data was exposed.

Just how bad can things get?​

One woman realized something was wrong after she got a text from the hospital. It said her ER wait time was extended, except … she wasn’t in the ER. She ignored the text, probably thinking it was just a wrong number.

The next day, she got a call to discuss her test results. That’s when she hit the panic button. It was too late — even though she reported the incident as fraudulent, she still got slapped with a $3,600 bill. She had to escalate things to the hospital’s privacy officer to get everything corrected.

It’s not just individuals using your medical ID; scammy organizations can steal your medical info for phantom billing schemes, too. They’ll submit false claims for medical services you never requested and leave you with the bill.

Signs and symptoms​

• You notice the medical info in your patient record is wrong, like your blood type or a recent diagnosis.
• You receive a bill or an Explanation of Benefits statement for health care services you didn’t get.
• You start receiving calls from debt collectors about medical bills you don’t owe.
• Your health insurance company claims you’ve hit your benefit limitswhen you know that’s not true.

Build up your immunity​

• Use this searchable database to see if your health care info has been compromised.
• Store hard copies of medical records in a safe or lockbox.
• Remove prescription labels from empty bottles before you toss them. These labels have information thieves can use.
• Monitor your credit. You can get three free credit reports a year at AnnualCreditReport.com.
• Report phony medical bills. If you get bills for medical services you didn’t receive, contact your insurance provider ASAP. After, report your billing errors to the credit bureaus at IdentityTheft.gov.

This one’s big: When hospital networks get hacked, it can keep you from getting lifesaving care. It happened already this year. Store digital copies of your medical records on your phone in case their systems go down. Here’s how.

Kids and older folks are prime targets for this stuff. Criminals bank on you not realizing there’s a problem until they’ve stolen your health care benefits. Pass this on to people you care about using the share icons below.

 

[VintageBetter]

We found that our Medicare Supplement insurance had paid some large claims to a fictitious provider. I say fictitious knowing that some sort of information was provided to get claims paid. Fact is it named a provider that supposedly did business in the town where we live, which is a rural community with only a small handful of businesses. It was very easy to verify to our Insuror that it was not a claim of ours. I've got to believe there is a form of identity theft involved, but we haven't found any other trace of it impacting us.

I hope you called that Medicare number to report it.