Medicare Fraud


 Recorded: March 28, 2012

Jim: Welcome to Fairfax County’s Medicare Moments, the podcast that brings you the latest information on Medicare.

I‘m your host, Jim Person.   Did you know that Medicare fraud is pulling billions of dollars out of our health care system?  

Today we will discuss Medicare Fraud and what you can do to prevent it.

Joining us is Howard Houghton, the manager of Fairfax County’s Virginia Insurance Counseling and Assistance Program.  

Welcome, Howard.

Howard: Thanks, Jim. Good to be here again.

Jim:  So, Howard, we have a Medicare fraud problem. How big is it?

Howard: Well, Jim, no one knows for sure.  Medicare doesn’t provide official estimates of the amount lost to fraud each year, but outside estimates put the number in the tens of billions of dollars.

Jim:  OK, I’d say that’s a problem. Let’s start with the basics: What is Medicare fraud?

Howard:  Fraud occurs when someone intentionally falsifies information or deceives the Medicare program.

Most fraud occurs by people who deliberately falsify bills. This can include hospitals, home health care agencies, nursing homes, hospices, lab services, wheelchair companies and medical transportation companies – really anyone who bills the Medicare program.

Let me point out that mistakes in billing, and this happens fairly often, are not  fraud though billing mistakes certainly need to be corrected.

Jim:  Howard, give us some examples of Medicare fraud.

Howard: Some typical examples of Medicare fraud are:

  • A healthcare provider bills Medicare for services you never received.
  • A wheelchair or oxygen company bills Medicare for equipment you never received.
  • Someone uses another person’s Medicare card to get medical care, supplies, or equipment.
  • Someone bills Medicare for home medical equipment after it has been returned.
  • A company offers a Medicare drug plan that hasn’t been approved by Medicare.
  • A company uses false information to mislead you into joining a Medicare plan.

 

Jim: I’m guessing you have a few stories to share?

Howard: Unfortunately, I do. One of the most famous cases involves a guy named Ike Odelugo who testified in Congress last year how about how easy it was to defraud Medicare. He said it was just a matter of entering data.

He stole almost $10 million in fraudulent billing for medical equipment that was either: not delivered, not medically necessary or not prescribed by doctors.

 He’s now serving 72 months in a federal prison.

Howard:  If you would like another story, here is a tale from Virginia. Ronald Poulin, an oncologist and hematologist, in Virginia Beach, was sentenced in March 2010 to 63 months in prison for health care fraud, making false statements relating to health care matters and altering records to obstruct an investigation.

Poulin was also ordered to pay restitution of over $790,000.

The evidence showed that between 2006 and 2008, Poulin filed hundreds of false claims totaling approximately $1.3 million with Medicare and Tricare.

The scheme involved three components: Poulin billed for a greater amount of chemo drugs than patients actually received; he split single-dose vials of an anemia drug between two patients and billed it as if each patient had received a full vial; and he billed for patient office visits which never occurred.

Jim: I understand that Medicare beneficiaries are actually the best watchdogs for Medicare fraud.

Howard: Yes, that is true. Every Medicare transaction has a paper trail and beneficiaries receive copies of most of this paper including a Medicare Summary Notice after every medically related service. They also receive medical bills for their copayments. To prevent inaccurate or fraudulent charges, beneficiaries should:

  1. Save all receipts from medical providers and
  2. Compare these receipts with the Medicare Summary Notice to make sure the date and service are correct.

And they don’t have to wait for their summary notices to arrive by mail. They can check Medicare claims early by visiting www.MyMedicare.gov or calling 1-800-Medicare. Beneficiaries of Medicare drug plans and Medicare Advantage plans need to call their plans directly about billings.

Jim: Let’s say you follow these instructions and find a discrepancy in your bill. What should you do?

Howard: Well, if it looks like an honest mistake, call your doctor or medical provider and discuss it with them. If you’ve contacted the provider and you suspect that Medicare is being charged for a service or supply you didn’t get, or, if you don’t know who the provider is on the claim form, call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

Jim: Are there other steps people can take to prevent Medicare fraud?

Howard: Yes – it is also important for beneficiaries to protect their Social Security and Medicare numbers from identify theft. I’m sure most of the audience has heard of identity theft in relation to credit cards.

Well, Medicare identity theft is rampant. Thieves often con people into giving them their Social Security and Medicare numbers – sometimes by offering free services or equipment. They then use that number to submit phony claims for thousands of dollars. 

My advice is to treat your Social Security and Medicare cards like you would your credit cards. Only give the card and the number on the card to a trusted provider.

Also, be suspicious of anyone who offers you free medical equipment or services and then requests your Medicare number. If it’s free, they do not need your number!

If your Medicare card is lost or stolen, you should immediately report it to Social Security at 1-800-772-1213 (TTY 1-800-325-0778) for a replacement.

Jim: I understand there is a program that gives free community presentations about Medicare fraud. Tell us about that.

Howard: You are referring to the Senior Medicare Patrol. This is a federally-funded program that trains volunteers to provide community presentations so that older adults and caregivers can identify and prevent Medicare fraud.

To request an SMP presentation for your community or faith group, call 1-800-938-8885. You can visit them on the web at www.virginiasmp.org.

At this same number – 1-800-938-8885 - you can also request a free monthly health care journal. Beneficiaries can use this to keep track of health care and record appointments so that when your receive bills and Medicare Summary Notices, you can check them against this record.

Jim: Well, there you have it. Howard mentioned a number of phone numbers and webpages and I’ll review them for you before we go.

For information on Medicare fraud, visit www.medicare.gov and for information about the Senior Medicare Patrol go to www.virginiasmp.org or call 1-800-938-8885.

As always, call the Virginia Insurance Counseling and Assistance Program if you encounter a problem with Medicare or need advice choosing a plan. The number is 703-324-5851, TTY 711.

Finally, for information on services for older adults, including assistance with Medicare issues, go to www.fairfaxcounty.gov/dfs/olderadultservices.

I want to thank our guest, Howard Houghton for talking to us about the ins and outs of Medicare and I want to thank our listeners for tuning into our show today.  Until next time, this is Jim Person with Fairfax County’s Medicare Moments.

Closing Music.


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