Residents receive tips on how to prevent Medicare fraud

(ROCKWALL, TX – Feb. 5, 2016) Senior Medicare Patrol (SMP) Advocate Mike Shipley presented residents with tips on how to prevent Medicare fraud during a special program held and sponsored by the First Christian Church Rockwall (3375 Ridge Rd.) on Wednesday, Feb. 3.

With close to 54 million people enrolled in Medicare around the U.S., cost for medical care totals about $600 billion per year. Fraud and abuse costs continues to grow, measuring roughly around $60 billion (10 percent of the total program). Shipley said the best way to prevent Medicare fraud has to do with three steps: protect personal information; detect potential errors, fraud and abuse by reading the Medicare Summary Notice; and report the suspected errors, fraud and abuse so that Medicare and other healthcare payers can recover the misspent money.

Shipley said the easiest way to prevent fraud would be to never carry your medical insurance card or social security card with you, but rather in a safe place at home where no one has an opportunity to steal important personal information such as a Medicare number or social security number.

“It’s not recommended to carry your insurance card, whether it be social security or major medical, with you on your person,” Shipley said. “Leave it in a safe place. If you’re in a medical situation and know you need your card, take it with you and protect it until you can get home and put it back in a safe place. This is about the only way you can prevent potential fraud.”

Shipley also strongly recommended to write down details of any doctor’s appointments: what the visit was for, what doctor you were seeing and where, what the doctor prescribed and what you ended up receiving. This documentation will help avoid any hassles if a fraudulent healthcare issue ever comes up, or if there are any mistakes on medical bills or payments.

“If you have an issue, you don’t want a surprise,” Shipley said. “You don’t want to have to go back and dig through months or years of paperwork trying to find out did I get this procedure done, did I see this doctor and did he tell me this.”

In the event a mistake does appear on a Medicare bill or payment, Shipley advised to report it within the 120-day grace period to prevent higher premiums, benefit cuts and legal issues down the road which could prove very costly.

“These agencies don’t know you have a problem until you tell them,” Shipley said. “When the medical bill payment goes through or is approved, unless you say something, no one in the system is going to know about it.”

Shipley said whenever healthcare fraud is committed, more than likely the fraud occurred as a result of the actions of more than one individual.

“Up to this point in my investigations into potential fraud, I’ve come to the conclusion that one person can’t do it; it takes two,” he said. “If somebody’s got your social security number or Medicare number and they go to a doctor for care, it takes two forms of identification. Somebody at the office, whether it’s a doctor or the system or whatever, has to say, ‘we’re going to take this.’ So it takes two people. I’m convinced of that.

“This is something that people give a lot of thought to. I don’t think fraud’s an accident by any stretch of the imagination.”

Those who think they might be a victim of Medicare fraud, or have any questions or concerns regarding their healthcare, can contact the following sources for assistance:

Texas SMP: 713-341-6184 or 1-888-341-6187

Quality of care concerns? Contact the Texas QIO: 1-800-725-8315

Social Security Administration: 1-800-772-1213 or 1-800-325-0778 TTY

Centers for Medicare and Medicaid Services (CMS): 1-800-633-4227 or 1-800-486-2048

Fraud Tips Hotline HHS Office of Inspector General: 1-800-HHS-TIPS

Federal Trade Commission ID Theft Hotline: 1-877-438-4338

Eldercare Locator: www.eldercare.gov

State Health Insurance Programs (SHIP): www.shiptalk.org

Long Term Care Ombudsman: www.Itcombudsman.org

SMP Locator: www.smpresource.org

The SMP is a voluntary organization involved with and supported by the Centers for Medicare and Medicaid Services and the Health Care Fraud and Abuse Control Program. It seeks to empower and assist Medicare beneficiaries, their families and caregivers to prevent, detect and report healthcare fraud, errors and abuse through outreach counseling and education. For more information, visit texassmp.org/.

Story and photo by Austin Wells, Blue Ribbon News staff writer.

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