Medicare Fraud

[shanam]

I realize that this topic is irrelevant to most of the people on the forum but I just watched "60 Minutes" and they did a report on phony companies in florida that were set up to defraud medicare. Defraud to the tune of 3-4 HUNDRED thousand per month. These thieves were able to buy lists of patient names, SS# etc. and file claims for equipment that these people never needed or got. They showed a woman who for 6 years complained to Medicare for services on her statement that she never received. medicare's response: we will look into it.
I bring this up only because there must be a complete overhaul on a program that must be run correctly.
Eventually, everyone will need this program and if it is not monitored it is just not going to be there when needed.
If you have parents on Medicare ...... read their statements or tell them to read them.

[Irishgal]

There is horrible fraud with both Medicare and Medicaid. It is crazy that Dept of Health and Human services does not make this a priority. For instance, have criminal investigators work with RNs to audit charts, etc.

[Vegas Long Legs]

Someone is constantly getting busted for Medicare & medicaid fraud in Vegas. Its amazing how greed has run rampant lately.

[nooch]

Thank you for posting this, it never would have occurred to me to check these things and I am not sure how vigilant my FIL is.

[barcreperie]

There are Medicare and Medicaid frauds at so many levels. 60 Minutes concentrated on people who set up fake businesses to make claims for medical equipment (prostheses, wheelchairs, etc) and presciptions.

What I noticed when my mom was on Medicare is the doctors that were committing the fraud - charging for visits and procedures that never happened. One of the more common frauds amongst doctors goes something like this: A doctor agrees to make 'house calls' to an assisted living facility or a nursing home. The doctor visits the place once or twice a week, eyeballs which of his/her patients are there at the time of the visit, and submits a bill for 'seeing' each one of them. 'Seeing' them might be noticing they're sitting across the room as they pass through the lobby.

It happened so many times with my mom, and her doctors knew she had family actively involved in her care. I can't imaging how often this happens with patients who have no one overseeing their care.

But Shanam, this topic is relevant to all in the U.S., whether they are on Medicare or have a family member on Medicare, because these are the funds that will fund Medicare when we in the U.S. retire. And I would imagine it's happening everywhere there's insurance, government sponsored medical care, or any third party payment plan in place.

[shanam]

^^Thank you barcreperie bfor pointing that out. when i watched this i thought more of the elderly who do not check their statements, etc. as andy rooney said in his commentary, a doctor came in to his room, said hello which he thought very nice until he saw her was charged $250 (i think) for that!!!!
i know at the independent living facility where my mother is a podiatrist comes in - clips toenails and charges $60!!!! and we wonder why there is a health care crisis

[NYCBelle]

my mom's old dentist was sent to jail for Medicaid fraud. He would put phony procedures in the claims and get paid. He got millions out of the city.

[barcreperie]

Originally Posted by shanam

^^Thank you barcreperie bfor pointing that out. when i watched this i thought more of the elderly who do not check their statements, etc. as andy rooney said in his commentary, a doctor came in to his room, said hello which he thought very nice until he saw her was charged $250 (i think) for that!!!! i know at the independent living facility where my mother is a podiatrist comes in - clips toenails and charges $60!!!! and we wonder why there is a health care crisis

Yep, my mom had a podiatrist come in to clip her toenails as well. I don't remember what he charged, but she was diabetic, which I assume is why they had a podiatrist do it.

The problem was faced was this: There was usually only one doc who came to the facility (my mom lived in several over the years). While we were checking the statements, if we reported the doc, then we possibly wouldn't have a doc coming to the facility, at least for awhile. It was a MAJOR hassle to get my mom out to a doctor's appointment, so we let it slide. Now that I've seen that 60 Minutes episode, it sounds like Medicare would have just blown off our reports anyway, but we didn't know that at the time.

Did we do the right thing? Probably not.

I want to point out though that it wasn't every doctor who did this, but it was amazing how many did!

[Allisonfaye]

I was just thinking about this the other day. I had a next door neighbor as a kid. I think he was an opthamologist and he went to prison for Medicare fraud. He was featured on 60 Minutes many years ago.

[BlkLadyLaw]

I saw this also! I Tivo'd it so I didn't watch until yesterday. It seems so easy to get away with. It was infuriating that they do not have better checks and balances and all these tax dollars that could go to better use to help people go to criminals pockets. Seriously this is why I am often a proponent of outsourcing some govt functions because in some cases they just do not seem to manage things as well or as efficiently as the private sector at times. I am in the DC area and know people hate when fed govt jobs here get moved to contractors but sometimes it is a smart move.

[lorihmatthews]

Originally Posted by shanam

i know at the independent living facility where my mother is a podiatrist comes in - clips toenails and charges $60!!!! and we wonder why there is a health care crisis

Does your mom at least get a polish change with that? Kidding!

I'm seeing my parents in December, I am going to take a look at their bills too.

[dusty paws]

i'll tell mom to go over my grandma's with a fine toothed comb.

actually... they had a dentist come out to look at my grandma. they told her that a whole ton of teeth needed to be pulled and that mom needed to schedule an appt for her. mom thought that was weird and took her to our family dentist... who said her teeth were perfectly fine.

if she had overlooked it and just said sure they would've pulled half my grandma's teeth for nothing. so please - if you have family in a rest home really watch what they do.

[shanam]

^^^you really do have to watch and take responsibility for elder members of your family.
i know the dentist wanted to do work that would make sense for someone younger, but at 90 years of age - no way. if there is no pain and they have gotten along this far -it is just a rip-off.
lori - polish change - LOL
and medicare really does not care about errors. my mother called on something she was billed for when she had to go to the ER for a cut and Medicare was like .....sure we will look into..... very frustrating.

[digby723]

They way this system is run is a joke. I had a sociology professor last semester who's mother has dementia. She is in a retirement community with a nursing/outpatient center that's on the premises as well. Well, apparantly last semester her mom fell down and injured herself, so she was transferred from her regular room to one of the rooms in the "hospital" on site. After about 12 days her mom was able to go back to her regular room, but the doctor told my professor that Medicaid would pay for a full 30 days of her being at the "hospital" so there was no need to move her! On top of that, her deceased husbands insurance that she was covered under would ALSO pay for something like 15 days, so they were getting money from them also! Meanwhile, it's her short term memory that's shot and she has a hard time remembering why she's there in the first place, but is comfortable and received better care in her regular room! So my professor made them move her mom back to her regular room. The nerve of some people...just because you can milk it for all it's worth, you're going to put others through pain or unnecessary treatments/things for the money??? I HATE HATE HATE how this country treats the elderly. Nursing homes or retirement communities are exorbitantly expensive, no one can truly afford the ones that have great care and it's not always possible to take care of your parents when they get older. In my professors case her moms dementia was so bad, especially with having young children in the house, that her stay at home husband couldn't care for his mother-in-law anymore, she kept having "fits" and it just wasn't logical to keep her in their home when they knew she wasn't getting the best care they could give her because they didn't know how to help her.

[shanam]

The system is broken and in serious need of repair. Seniors are taken advantage of because trying to understand what you are entitled to under medicare is almost impossible for these people without help. when the RX supplemental went into effect, i spent hours researching the right one for my mother based on what her RX's were and the generic vs. tiers, etc. which i could hardly make sense of. there is a formulary on the Medicare web site, but how many elderly know how to use it? my mother kept saying, all my friends go through AARP. of course - they have excellent marketing and make it seem like the plans they sponsor are the best and take all the work out of it It is very unfortunate that many elderly do not have anyone who can help them and they do not know their rights and what they are entitled to. They make things so complicated that it is just easier to just stay with what you have then try and figure out how to save
money.