Order photos

Fight back against Medicare fraud

by | Jun 4, 2015 | Opinion

By Bob Moos

Southwest public affairs officer for the U.S. Centers for Medicare & Medicaid Services

The owner of a Houston area ambulance company receives a 97-month prison sentence for submitting $2.4 million in claims to Medicare for services that weren’t necessary and, in some cases, never even provided.

Two unlicensed medical school graduates each get 72 months behind bars for acting as physicians in a Dallas area house call practice and billing Medicare $2.7 million for home visits and diagnostic tests never performed.

A Houston man receives a 87-month prison term for recruiting Medicare and Medicaid beneficiaries, using their personal health information and billing the government for motorized wheelchairs never delivered.

For too long, the crooks who were behind health care fraud were often one step ahead of law enforcement. But that’s finally changing. Thanks to better coordination among federal agencies and the introduction of cutting-edge technology, more criminals are being brought to justice.

The Department of Health and Human Services and the Department of Justice now have a task force that targets areas with suspicious Medicare billings. The “HEAT Team” crime investigators sift through claims data to identify billing patterns that suggest someone has run afoul of the law.

Complementing the state-of-the-art data analysis has been some hard-nosed police work. The Medicare Fraud Strike Force – made up of interagency teams of investigators and prosecutors – now operates in nine areas known as fraud hot spots, including Dallas, Houston and Southern Louisiana.

The sophisticated detective work has paid off. Strike Force prosecutors have charged more than 2,100 defendants with fraudulently billing Medicare more than $6.5 billion. Their current conviction rate is 95 percent, and the average prison term exceeds four years.

In the past, most of the government’s anti-fraud efforts focused on chasing after taxpayer dollars only after the swindlers had stolen the money. But the Affordable Care Act has given the government more tools to keep the unscrupulous out of Medicare in the first place.

Now, more rigorous screening measures prevent fraudulent providers and suppliers from enrolling in Medicare and filing false claims. The law also lets the government suspend payments to providers and suppliers suspected of fraud until the allegations can be investigated.

Yet, as important as all these aggressive initiatives are, the first and best line of defense against fraud remains you – the health care consumer.

So here are a few ways you can protect your Medicare benefits:

  • Guard your Medicare number. Fraud schemes often depend on crooks first getting hold of people’s Medicare numbers. So treat yours as you would a credit card. Don’t share it with anyone except your doctor or other Medicare-approved health care provider. If you don’t know whether a provider has Medicare approval, call Medicare at 1-800-633-4227 and ask.

 

  • Look out for suspicious activities. Be wary of salespeople who knock on your door or call you uninvited and try to sell you a product or service. Don’t allow anyone except your doctor or other Medicare-approved provider to review your medical records or recommend services. And never let anyone give you “free” equipment or supplies in exchange for your Medicare number.

 

  • If you have Original Medicare, check your Medicare Summary Notice. Use a calendar or personal journal to record all of your doctor appointments and tests. Then review your quarterly claims statement to make sure Medicare wasn’t billed for something you didn’t get. If you spot what you think is an error, call the doctor’s office or health care provider and ask about it. If they can’t resolve your questions or concerns, call 1-800-633-4227.

 

  • Report suspected cases of fraud. If you think someone has misused your Medicare number, call 1-800-633-4227 or the ID theft hotline at the Federal Trade Commission at 1-877-438-4338. If you suspect Medicare fraud, call the inspector general’s fraud hotline at the Department of Health and Human Services at 1-800-447-8477.

Fraud isn’t a victimless crime. Illegal schemes waste tens of billions of dollars each year and drive up everyone’s health care bills. If we’re to protect Medicare from fraud, we all need to pitch in.

 

NTMWD Plant Smart 2024

0 Comments

Related News

35 Texas counties eligible for individual disaster aid

35 Texas counties eligible for individual disaster aid

Residents in a total of 35 Texas counties now qualify for individual disaster assistance following a series of severe storms and flooding that began in late April, The Dallas Morning News reported. “I thank our federal partners and emergency response personnel across...

read more
Texas could face long-term water supply deficit

Texas could face long-term water supply deficit

Texas is facing a reckoning on water that we must address if the state wants to secure its future prosperity. The State Water Plan prepared by the Texas Water Development Board projects that Texas faces a long-term water supply deficit of 6.9 million acre-feet in 50...

read more
Hogging the channels

Hogging the channels

 I have a lot of my grandparents in me. I’m cheap. I also love the Arkansas Razorbacks. Nowhere is this truer than when it comes to radio, television, and an Arkansas game. I grew up listening to free radio and watching free television. So, the idea of paying...

read more
Laundry: There’s more than one way to fold

Laundry: There’s more than one way to fold

You would think that there’s only one way to fold towels. But, you’d be wrong. Growing up in Ashdown, Arkansas, my momma showed me how to fold them, as well as shirts, socks, underpants, and other personal sundries. I assumed that this skillset would carry me all the...

read more
The Lawn Moore

The Lawn Moore

America really is The Land of Opportunity. Even if there’s only one opportunity, and that opportunity is cutting the grass.  Ashdown, Arkansas, was a pretty typical small American town in the 1960s and 1970s.  Kids weren’t just handed things. If we wanted...

read more
A myth understanding

A myth understanding

In the South, we believed with all of our hearts what we were told when we were children. Even if it was wrong. In the 1960s, the RCA color console TV my family had on Beech Street in Ashdown, Arkansas, could make you go blind. It could if you believed what our mom...

read more
On the road again and again

On the road again and again

Back in the 60s, some American college kids protested the Vietnam War, but mostly, they conducted sit-ins. Few protests were violent. Other American college kids would have contests to see how many of them they could cram into a Volkswagen. Today, some college kids...

read more
Aisle be seeing you

Aisle be seeing you

As a child growing up in Ashdown, Arkansas, we had two main grocery stores. Shur-Way and Piggly Wiggly. Or as my dad called it, “Hoggly Woggly.” A trip to the store was like each TV commercial had come to life. Advertising agencies at the time were very good at what...

read more
Just plane fun

Just plane fun

My wife and I are scheduled for an Alaskan cruise in the fall. By all accounts, it’s something to which we should look forward. I’ve been told the same thing about other trips, including a Vegas excursion that included a stay at a strip motel that still had beds that...

read more
Fixer Uppers

Fixer Uppers

Recently, I saw something I haven’t seen in many years. A young man driving a car he was fixing up. It was an older Mustang. By older I mean a 90’s model. The car had spots of primer, there were a few dents, and the exhaust system appeared to be loose. By John Moore...

read more
Subscribe Love