MEDICARE FRAUD ON THE UNSUSPECTING AND VULNERABLE

Dec 14th, 2012 | By Sharon Shaw Elrod MSW EdD | Category: Social Security & Medicare

Review Medicare Statements Carefully

Every caregiver with responsibility for checking and paying bills for elderly loved ones has a responsibility to check for Medicare fraud. You might be thinking, “How in the world do I do that?”  This true story might help you determine what you can do.

Eight months ago, when an elderly loved one was in a nursing home, a mobile medical service arrived at the front door.  They were ‘scheduled’ to provide screenings for balance and mobility, and they also checked for things like impacted ear wax and toe nails that needed trimming. 

Somehow during the course of the day, they did screening for an elderly woman whose family carefully reviewed every medical statement that Medicare and the supplemental insurance company paid. The family soon discovered their elderly loved one had been seen by this mobile medical service for an ‘initial’ charge of $260; she was given a ‘physical performance test’ for $55; and she had impacted ear wax removed to the tune of $100. The family provided oversight for their loved one’s medical needs, and were highly suspect of services provided that they were not aware of.

Take Action Against Medicare Fraud

This elder’s family had an agreement with the nursing home that they would be consulted before any new medical service/care was provided.  There was no need for a physical performance test and the family routinely cleans this woman’s ears with over-the-counter Debrox, costing nothing close to $100.  The family chose to take action, wrote Medicare complaining of the charges and asked for a review; they strongly suspected Medicare fraud, but it could not be proven without a review. They believed the services for which Medicare was charged were unnecessary, and were only ‘provided’ because Medicare would pay for them.

Now, eight months later, they received a statement from Medicare indicating the charges were not paid, and the provider is no longer eligible to receive Medicare funds. Fraud or not, this mobile medical service will no longer be able to provide unnecessary medical tests and screenings on vulnerable elderly people.  The family had an honorable hand in helping put a dent in Medicare fraud.  Every family with responsibility for providing financial assistance to the elderly needs to carefully review Medicare and other insurance statements for the possibility of fraudulent charges.



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