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Seniors and Health Care Fraud

Protecting Yourself From Health Care Fraud

Protecting Yourself From Health Care FraudIt’s an issue – health care fraud - a huge issue. At a time when we’re so very concerned about health care costs, it’s truly a crime to waste money to fraud. The estimates of the amount of fraud vary, but all are huge:

  • $80 to $160 billion across the US
  • 10% of the money spent in the Medicare and Medicaid programs
  • $10 billion in direct spending by consumers.

There are several components to health care fraud and it’s about more than money

  • Unsafe or ineffective drugs as THE CURE for one ailment or another
  • Billing for services or items not provided
  • Falsifying a diagnosis in order to justify tests, procedures or equipment that aren’t medically necessary
  • Mis-representing procedures to obtain payment for non-covered services such as cosmetic surgery
  • Accepting kick-backs for patient referrals
  • Billing a patient for more than their co-payment or for more than the amount allowed by the health plan
  • Using someone else’s coverage, personal information or insurance/Medicare card.
  • Billing Medicare for services that should have been included in another service, for example, medical equipment for people in nursing homes or for a test you received while in a hospital.

What to Do About It?

Medicare, Medicaid and insurance companies spend a great deal of time and energy trying to detect fraud and they’re getting better at it. The first line of defense is at the consumer level. Your vigilance can prevent health care fraud.

The following are some tips (and there are several resources listed below) that help you be on guard against fraud:

  • Ask questions about the services you receive: Why are they needed? What is the cost?
  • Question advertisements or promotions that offer free tests, treatments or services. Be especially careful if the person offering these “free” services asks to copy your insurance card.
  • Protect your Medicare/Medicaid or insurance card information as you would any valuable set of numbers. It’s as valuable as your banking or credit card information
  • Keep a record of health care services and products you received. The Personal Health Record provided to members of the interim HealthCare CHOICE Network can help you do this. Keep a notebook or journal.
  • Compare every explanation of benefit payments from Medicare or your insurance company with your recollection/record of services and products you received. Are the dates of service correct? Are there any services or procedures paid that you didn’t receive? Research items that your insurance company or Medicare paid that you don’t remember. Call the provider and ask them to explain.
  • Do your homework and talk to your health care provider before buying or investing in “cure all” or “miracle” products or services.
  • Follow your instincts and the old adage: if it seems too good to be true, it usually is.

How Can I Report Suspected Fraud

Medicare

800.447.8477 (TTY: 800.377.4950)

Online: http://oig.hhs.gov/fraud/report-fraud/index.asp
Mail:
HHS Tips Hotline
PO Box 23489
Washington, DC 20026-3489

Medicaid

888.NO.CHEAT (888.662.4238)

Managed Care or Insurance Plan (Blue Cross and Blue Shield, Humana, Aetna, Cigna, etc.) Call the number on your Identification Card

At Interim HealthCare of the Upstate, Integrity is the first of our core values. We have a voluntary integrity and compliance program that aggressively trains all our staff on doing the right thing and researches any concerns. We operate with the utmost concern for doing the right thing in the right way. Surely that includes patient care. It also includes all our dealings with our patients and with the companies and entities that pay for services. Our commitment to integrity is why we are so careful in applying the eligibility and coverage rules of Medicare or insurance plans. For example, we assure that all our Medicare home health and hospice patients meet all eligibility criteria and work with your physician to verify eligibility. Please call us any time you have a question or concern.

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