By Nelva Hernandez
Medicare is a federal government program that provides health care coverage for people over 65, those who are under 65 and receiving social security disability insurance and those under 65 and diagnosed with end-stage renal disease or amyotrophic lateral sclerosis.
It’s a valuable program, but Medicare loses billions of dollars because of billing errors, abuse and fraud. You can help prevent Medicare waste and fraud and ensure that Medicare is around for generations to come.
Errors
Medicare is a complex program with complicated rules and procedures, which can lead to human error in processing and billing claims. For example, there could be two beneficiaries with the same name and the charge was assigned to the wrong person.
What can you do in a situation like this? Always review your Medicare summary notice for errors and report any inaccuracies to your doctor’s billing office.
Abuse
Medicare abuse involves payment for items or services when there is no legal entitlement to that payment and the provider unknowingly or unintentionally misrepresented the facts or diagnosis to get payment.
An example could be billing Medicare for services that are not medically necessary or not provided.
Make sure to keep records of dates and services and compare them to your Medicare summary notice. If there are any inaccuracies, report them to your doctor’s billing office, Medicare at 800-633- 4227 or Senior Medicare Patrol at 800-938-8885.
Fraud
Medicare fraud is intentional deception or misrepresentation that the individual knows to be false. This deception could result in some unauthorized benefit for the individual or some other person. Knowingly and intentionally billing for services or supplies that were not rendered with the objective to get payment would fall under this category.
To prevent a situation like this, protect your Medicare and social security number – don’t provide this information to anyone other than doctors or people you know should have it. Do not accept unsolicited phone calls or respond to mailed offers, and do not accept offers for “free” medical care.
Report any inaccuracies to your doctor’s billing office, Medicare or Senior Medicare Patrol.
All errors, abuse and fraud can also be reported to the Bureau of Insurance at 804- 371-9741 or https://scc.virginia.gov/pages/File-Complaint-Consumers.
Here are some organizations that can provide additional information and resources to assist you if you believe you are the victim of Medicare errors, abuse or fraud.
The Virginia Senior Medicare Patrol, a volunteer-based organization funded by the U.S. Department of Health and Human Services, has expertise, training and technical support to maximize the effectiveness of fraud/abuse prevention outreach and education. The SMP Resource Center also provides education on ways to prevent, detect, and report Medicaid error, abuse, and fraud.
The Center for Medicare and Medicare Services is the agency within the U.S. Department of Health and Human Services that administers Medicare and Medicaid insurance. CMS collects and analyzes data, produces research reports and works to eliminate instances of abuse and fraud within the healthcare system.
The writer is a family services specialist in the city’s Division of Aging and Adult Services in the Department of Community and Human Services.
