ShareThisTo Betty McLoughlin, learning about Medicare fraud is a necessary evil.
"It affects our finances," said McLoughlin, 82, who lives in Abilene, Texas, and has received training from the Senior Medicare Patrol, a group that educates seniors about Medicare fraud and encourages them to report it. "The more fraud there is in the United States, the more it will affect our premiums and our deductibles."
Health officials, physicians and others are equally vocal in their desire to see Medicare fraud, estimated to be between $60 billion and $90 billion each year, eliminated.
"Every dollar that's wasted in fraud could have been applied to the Medicare population for services," said Bruce Malone, president of the Texas Medical Association.
Only rarely are patients involved in Medicare fraud, Malone said, with many perpetrators instead being "well-organized" criminals who have somehow been able to get access to patient information and often operating under the auspices of dummy companies,
The new Affordable Care Act gives the government more tools to keep the unscrupulous out of the Medicare and Medicaid systems, said Bob Moos, southwest public affairs officer for the Centers for Medicare and Medicaid Service.
More rigorous screening measures will prevent fraudulent providers and suppliers from enrolling in Medicare or Medicaid and filing false claims, Moos said, with particular attention paid to certain kinds of businesses with a long history of fraudulent billing.
"The new law also lets the government suspend payments to providers and suppliers suspected of fraud until the allegations can be investigated," Moos said in an email, adding that there are also stiffer civil and criminal penalties to make people "think hard about whether it's worth their while to steal from the health care system."
Better coordination among federal agencies and improved technology means more people attempting to commit fraud are being brought to justice, he said.
But as important as such tools may be, health consumers are still "the first and best line of defense against fraud," Moos said.
Moos said that consumers should be on the lookout for suspicious activities, including salespeople who knock on doors or call uninvited to try to sell a product or service.
No one except one's doctor or other Medicare-approved provider should be allowed access to medical records or recommend services, he said, and consumers should also not fall for schemes offering free equipment or supplies in exchange for a Medicare number.
The fraud issue becomes occasionally complicated for physicians, Malone said, when attempts are made to "criminalize" occasional honest mistakes in records.
Issues also come into play when debating the issue of charges deemed by some to be wasteful, he said, though the medical system is working to "create best practice guidelines to eliminate things we consider unnecessary for the treatment of the patient," a goal that should ideally "provide significant cost savings."
Those who suspect someone has their Medicare number should call 1-800-MEDICARE or the ID theft hotline at the Federal Trade Commission at 1-877-438-4338.
Those who suspect Medicare fraud, can call the inspector general's fraud hotline at the Department of Health and Human Services at 1-800-447-8477.
(Brian Bethel is a reporter for The Abilene Reporter-News in Texas
