Legislative Watch: Medicare and Medicaid Fraud Fighting Intensifies

Medicare and Medicaid fraud has gone on for years, in some instances, as unscrupulous operators and insurance companies bill for services that are never provided or overcharge for items or services that are provided.  Certainly the government has created systems that invited fraud, without proper checks and balances.

Oddly, some industry associations are still wanting barriers to systems being put in place to combat fraud.  The American Medical Association does not want doctors to have to show their billings - which would be an easy way to prevent fraud in this area.  In addition, Medicare home care could soon require a co-pay by seniors which would definitely eliminate seniors having services that were not needed.

Wheelchair and scooter fraud has also been part of the fraud, with the government providing reimbursement as high as $4,000 for an electric wheelchair.  Medical equipment companies would provide a scooter for $2,000, not a quality electric wheelchair, and pocket the difference.  The Scooter Store has created an entire business around taking advantage of the extremely high reimbursement rates for electric wheelchairs.  Electric wheelchairs really require custom fitting , with the purchase process as sophisticated as buying a nice car, if they are to function properly for each individual. The Scooter Store had a whistle blower who also let the government know they were hiring their own doctors to approve of the need for a scooter.  This same fraudulent practice has been conducted for Medicare home visits for skilled care, such as Registered Nurses, Physical Therapists, Speech Therapists, Occupational Therapists.

Be aware that fraudsters are attracted to this industry.  Here are some ways to protect against Medicare fraud:

• Don't give out your Medicare or Social Security number to strangers
• If your Medical Doctor makes a referral to a medical equipment company or Medicare home health agency, ask them if they are on their board of directors or receiving a referral fee and then ask them to give you 3 names of companeis, which is the standard followed and recommended by hospitals and professionals
• Don't let anyone borrow or use your Medicare card
• If you lose your Medicare card, report it immediately, just like you would with a lost credit card
• Check account notices from Medicare and your Medicare drug plan.  Look out for double billing and charges for items you did not receive or your doctor did not order.  Notify Medicare when questionable charges appear

The fraud involving wheelchairs have included sham companies being set up and approvals for wheelchairs and home care services being made for seniors whose information has been stolen.  Then when a senior later needs a wheelchair they discover they already received one when they did not.

In the Chicago, Illinois area, a Chicago nurse was charged with paying kickbacks to various health care providers in exchange for referrals to her home health agency, Goodwill home Healthcare, Inc., of Lincolnwood.  Another agency, Chicago's Chalice Home Healthcare Services, Inc., was charged with a criminal indictment with falsifying documents in an effort to boost Medicare payments.  The alleged scam included listing patients as home bound and needing assistance when they did not.

The current changes to Medicare home care services would include co-pays for seniors to eliminate this type of fraud.

You may find out if a health care company or provider is approved by Medicare by calling:  1-800-633-4227.  You may report portential fraud to federal authorities by calling:  1-800-447-8477.

Medicaid, for low-income seniors, is regulated by each state.  You may contact your state's Medicaid services through Caregiverlist's "By State" information pages, to report Medicaid fraud.