Call Now to Speak with a Care Manager Speak with a Care Manager Now: 484-350-3874

How to Prevent Medicare Fraud

By Dian Brannen, 9:00 am on

The FBI estimates that approximately ten percent of all health care billings may be fraudulent. However, inaccurate billing, whether deliberate or accidental, is just one form of Medicare fraud and abuse that seniors and their in-home caregivers should be aware of to prevent costly losses.

Check Medicare Statements

Medicare sends out monthly statements that show all costs billed to Medicare up to that point. Check each statement for:

• Duplicate billing (may include honest errors due to coding issues)
• Charges for services or tests not received or performed
• Higher than usual charges for services or tests previously performed at lower rates (could be a sign of intentional over-billing)

Question an Insistence on Further Testing

Some medical providers may encourage Medicare patients to schedule more tests with the claim that doing so means less out-of-pocket expenses. This is false since some Medicare benefits have limits–with the extra costs usually passed along to recipients.

Be Cautious of Sudden Solicitations

Attempts to sell equipment and supplies often needed by the elderly may be made door-to-door, over the phone, or through online solicitations. As a general rule, home care agencies in the Lehigh Valley encourage seniors to go directly to their doctor or a verified Medicare services provider for supplies and equipment, especially when claims are made that Medicare will cover everything regardless of what’s ordered.

Know Whether or Not a Co-Pay Is Required

Some Medicare plans require little or no co-pays, so a sudden insistence on a co-payment should be viewed with suspicion if one was never required previously. Since it’s possible that terms of a plan may have changed, there’s nothing wrong with seniors insisting on verifying the co-pay before paying it. Most reputable healthcare providers won’t mind cautious patients.

If Medicare fraud is suspected, check with the healthcare provider first to determine if honest billing or coding errors occurred. Instances of suspected fraud can also be reported directly at (800) 447-8477 or the incident can be described in an email (up to ten pages) and sent to HSTips@oig.hhs.gov.

Learn more about promoting a safe and healthy lifestyle for your senior loved one from the friendly staff at Home Care Assistance. As a trusted provider of hourly and live-in care, as well as stroke, dementia, and Alzheimer’s care in the Lehigh Valley, ensuring seniors have the necessary support to comfortably age in place is our top priority. Give us a call at 484-350-3874 and request a free in-home consultation to learn more.