Putting an End to Medicare Health Care Fraud

Putting an End to Medicare Health Care Fraud

The Obama administration has outlined new federal enforcement measures in an effort to combat Medicare health care fraud, like what recently happened to one Los Angeles internist.

According to a story in the Los Angeles Times, Dr. Anne Peters' suspicions were aroused when a fellow doctor asked why she was ordering so many MRIs for her patients. That's when she tried to tell authorities that someone was using her physician identification and Medicare billing number to illegally submit claims. The problem was that no one would listen to her. The patients who were the victims had to complain.

"I've heard that in Los Angeles Medicare fraud has reached crisis proportions," indicates Alan Weinstock, insurance broker at http://www.MedicareSupplementPlans.com. "Not only does it result in time and effort to track down and correct, but it drives up the cost of health care and impacts the long-term solvency of the Medicare program."

New Medicare Fraud Ruling

In an effort to further combat Medicare fraud, the Centers for Medicare and Medicaid Services (CMS) recently issued a regulation to protect seniors against fraudulent medical equipment and supply vendors.

It will require suppliers of prosthetics and other items to maintain proper ordering documentation and to remain open to the public at least 30 hours a week. It also will bar such companies from using cell phones or pagers as primary business phone numbers.

Before authorities unraveled the Los Angeles Times story, the Medicare fraud ring stole the identities of 19 physicians and used them to defraud Medicare of nearly $7 million.

Handling Medicare Fraud

The CMS recognizes that many Medicare payment errors are unintentional mistakes and not the result of any wrongdoing on the part of the physician, provider or supplier. However, anyone who has a question or concern about a Medicare claim that is submitted on their behalf should discuss it with the individual who provided the service.

The effort to prevent and detect fraud involves CMS, you, service providers and State and Federal Agencies such as, the Department of Health and Human Services Office of the Inspector General, the Federal Bureau of Investigation (FBI), and the Department of Justice.

However, Medicare beneficiaries are the most important link in the Medicare fraud chain. They know what services have been rendered. That is why it is important to review the Medicare Summary Notice when you receive it and ask questions if anything seems suspicious or you don't remember having a particular service.

If you suspect fraud, contact the Office of the Inspector General by phone at 1-800-HHS-TIPS (1-800-447-8477) or email at HHSTips@oig.hhs.gov. You'll need to provide the provider's name and any identifying number you have, the item or service you are questioning, the date of service, the amount paid by Medicare, the date of the Medicare Summary Notice, the name and Medicare number of the person receiving service and the reason you believe Medicare should not have paid.

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