Protecting Yourself Against Medicare Fraud

The New York Times recently reported that peripheral neuropathy sufferer and Vietnam veteran Jerry Gilman was approved by his doctor and Medicare for a motorized wheelchair from a company called Hoveround. The chair that arrived was a much lower quality than the chair that had been ordered. Hoveround refused to send the correct chair and Medicare would not pay for a second chair until Hoveround refunded the money from the first chair. An advocate finally untangled the Medicare-Hoveround impasse, and the correct wheelchair was eventually delivered. It was found that someone intercepted the order for the chair and instead sent a cheaper one to Gilman, pocketing the difference.

This is just one real-life example of how easily Medicare fraud happens. In this instance, the service provider billed Medicare for a medical product that wasn’t delivered. In truth, many types of Medicare fraud are perpetrated on a regular basis, such as:

  • Bills for services not rendered — It’s not unusual for medical practitioners to bill for gang visits at nursing homes where most or all of the residents are billed for a physician visit, even though the physician only saw a few patients.
  • Upcoding — Excessive billing practice where a provider places a bandage over a cut, for example, then bills for surgery.
  • Unbundling services — Billing for separate lab services for one blood draw that covered 3-4 tests, causing Medicare to pay multiple times for one service.
  • Bribe, kickback, offer or solicitation — For example, cappers approach Medicare recipients offering promotional items in exchange for ordering unnecessary medical equipment.
  • Non-covered services billed as covered — Billing for foot surgery (covered), for example, when a routine toenail clipping (non-covered) was actually performed.
  • Medicare marketing rules not followed — Knowing a premium is charged for the Part D prescription plan, offers the plan at no cost.

You can protect yourself against Medicare fraud and abuse by asking questions, reviewing your explanation of benefits and summary notices to make sure they match the services rendered, refusing unnecessary medical services ordered “just because Medicare will pay,” and protecting your Medicare card just like your Social Security card.

If you are the victim of Medicare fraud, please contact a licensed attorney who can advocate on your behalf.