The U.S. government does not provide universal health care, but pays out an estimated $60 billion a year in fraudulent Medicare claims - that is $60 billion with a "b". A private business that has to earn a profit in order to pay employees and cover their operating costs would not keep their doors open if they had this amount of fraud. The Obama administration realizes the government is partly to blame for creating a system which allows this much fraud to happen. They have setup a website
to educate seniors and caregivers about Medicare fraud and to assist us all in reporting it.
How can we stop Medicare fraud?Learn about how Medicare fraud happens.
Check out 60 Minutes reporting
on Medicare fraud to understand the system better. It is important to realize that the reimbursement claims for home care visits for Medicare skilled care (care provided by a Registered Nurse, Physical Therapist, Occupational Therapist, Speech Therapist) pay very generous amounts to the Medicare agencies for the visits: $500 per visit for a R.N., for example. The claim system is complicated - some visits pay more than others - filing a claim is similar to filing a federal tax return. However, Medicare agencies quickly learn the system and so do those who are seeking to abuse it. The same type of care for various medical diagnoses pay different reimbursement rates, for example.Ask questions.
If you or your spouse or relative are receiving skilled care visits by Medicare, ask the agency what the government reimbursement amount will be and based on what qualifying factors. Ask them how long the care has been approved for and confirm with your referring doctor - - - all Medicare visits must be doctor approved.Ask your doctor if he is associated with the Medicare agency.
While referral fees are not allowed, doctors are often invited to be on the advisory board or receive other incentives to refer to a certain agency - find out why the doctor refers to the agency and if they refer to more than one agency.Medicare Fraud Warning Signs:
- Service is offered for free - free medical equipment or additional free caregiving services
- No approval needed for services
- Door-to-door sales call or telemarketing call asking for your Medicare number for pre-approval
- Medicare is offering you the service for free and a random company is calling to notify you
Note: Medicare services are pre-approved by your medical doctor after a hospital or nursing home stay and require you to be confined to your home. Remember, even wheelchairs paid for by Medicare require extensive forms to be filled out, along with pre-approval from a medical doctor (and the Scooter Store, which advertises on Infomercials that they will get your wheelchair pre-approved for you definitely has the legal right to educate you about the Medicare approval process, but as they found out when they were convicted of Medicare fraud, they cannot hire their own doctors to drop by and approve you for a wheelchair). You may review the Scooter Store Medicare fraud case
which also is an indication of the generous reimbursement rates for some Medicare-approved services which is a reason for the high rates of fraud.
Learn more by reviewing information presented at the national summit on health care fraud
. Senior caregivers should also make sure a senior checks with their doctor before moving forward with any Medicare service, as only their medical doctor will authorize the Medicare home care services.MedicareFraud