Posing as nurses, they go door to door looking for seniors who may want help. Those who answer affirmatively are then asked for their Medicare or Medicaid number and billed for services – whether or not the service is ever provided.
This practice has run rampant throughout much of New Jersey, particularly in apartment buildings catering to seniors.
“It’s a popular Medicare/Medicaid scam that costs the government millions of dollars,” said Ken Wessel, executive director of Home Care Options, a non-profit home health agency servicing Passaic County. “Once seniors unwittingly give out their Medicare or Medicaid number, these insurance crooks are off to the races.”
Combating this problem through education is the goal of the New Jersey Healthcare Advocate Volunteer Effort (NJ HAVE), under the auspices of Jewish Family & Vocational Service of Middlesex County (JFVS), which is part of a federally funded national effort named the Senior Medicare Patrol (SMP) Program. The program consists of 64 community-based projects located in every state, as well as the District of Columbia, Guam and Puerto Rico.”Medicare and Medicaid fraud is a huge problem that the federal government hopes to tackle by teaching Medicare and Medicaid beneficiaries how to avoid becoming victims of fraud, waste and abuse,” said Charles Clarkson, an attorney and coordinator of NJ HAVE. “Everyone has a stake in this because the money lost to these practices has an impact on premiums and deductibles, and could result in cutbacks that would leave certain services uncovered.”
It is estimated that health care fraud, errors and abuse in Medicare alone cost the government as much as $21 billion a year. Medicaid lost another $16 billion. $1 out of every $10 spent on public insurance programs like Medicare and Medicaid is lost to fraud, waste and abuse in the U.S. Health care fraud, waste and abuse are estimated to cost up to $160 billion a year.
JFVS, the state’s non-profit grantee for NJ HAVE, partners with reputable agencies like HomeCare Options to raise awareness and offer solutions.
“You find abuse with all sectors of the healthcare industry, home health care, hospitals, nursing homes, pharmacies, medical supplies,” said Clarkson. “You see hospitals charging patients $100 for a ‘mucous recovery system,’ which is a box of tissues; pharmacists giving a customer 28 pills instead of 30; and equipment companies billing for a motorized wheelchair and giving the patient a scooter instead.”
National Medicaid Fraud statistics published in 2003 by the Medicaid Fraud Control Units around the US indicate that NJ had the highest Medicaid Fraud recovery in the entire country.
NJ HAVE hopes to make consumers more aware of the problem by offering these tips:
? Remember that only personal physicians, hospitals or clinics are permitted to make referrals for special equipment, services or medication.
? Never show anyone your medical or prescription records without first talking to your doctor or pharmacist.
? Don’t give out your Medicare or Medicaid information in person or over the phone until you are sure that the person works with Medicare or Medicaid. People representing Medicare or Medicaid will never come to your door uninvited. Medicare Drug Prescription Plans cannot enroll you into a drug plan over the telephone unless you call them.
? Shred your Medicare or other health care papers before throwing them away. Crooks will go through the trash.
? If someone offers to buy your Medicare or Medicaid number, don’t do it.
? Remember that Medicare doesn’t sell or endorse anything.
? If you suspect an error or fraud related to health care, gather the facts and report it.
? Always read your Medicare Summary Notice (MSN) or health care billing statement, which is stamped “This is Not a Bill” that comes in after your get medical care.
Look for three things in particular: charges for something you didn’t receive, billing for the same thing twice, and services that were not ordered by your doctor.
“Fraud is causing costs to go through the roof,” said Clarkson. “It all begins and ends with the consumer, which is why educating them is so important.”