By Sara Duris
Q. My father went to a local health fair and was offered a knee wrap to help his arthritis. He was told it was free but on his recent Explanation of Benefits, it appears Medicare was billed for an expensive knee brace that isn’t even like what he got from the vendor. The provider listed is one my father has never seen. What can we do?
A. This is likely an example of durable medical equipment (DME) Medicare fraud and should be reported to Senior Medicare Patrol and other appropriate entities. It highlights the importance of consistently reviewing your Medicare Advantage Plan Explanation of Benefits (EOB) or the Medicare Summary Notice (MSN) that is sent to those on original Medicare A and B. While there can be honest health care billing mistakes, the fact that your father accepted something that was represented as free and then billed as something very different seems to point to fraud, and that his Medicare number appears to have been compromised.
Medicare fraud is one of the most rampant forms of fraud in the United States and Medicare loses an estimated $60 billion each year due to fraud, errors, and abuse. When people steal from Medicare, it hurts us all and is big business for criminals. Stealing from Medicare leaves less available funds for those needing services now as well as those needing Medicare in the future. Last week was Medicare Fraud Awareness Week, so it’s a good time to review some common examples of fraud to watch for, and the steps to take if you find an error or suspect fraud.
Examples of fraud, errors, or abuse could include:
- Charging for services or supplies that were not provided
- Misrepresenting a diagnosis, a person’s identity, the service provided, or other facts to justify payment
- Prescribing or providing excessive or unnecessary tests and services
The Senior Medicare Patrol (SMP) is a national program that helps Medicare beneficiaries, their families, and caregivers to prevent, detect, and report health care fraud, errors and abuse through outreach, counseling and education. SMPs make determinations about whether fraud, error, or abuse is suspected and can assist in referring cases to the appropriate state and federal agencies for further investigation. To connect with Michigan’s SMP, call 1-844-677-6424 or go to www.michigan.gov/mdhhs and click on services for Adults and Seniors. The SMP is listed under Aging, Community Living, and Supports Bureau (ACLS.) You can also contact Medicare directly to report suspected fraud at 1-800-633-4227 or online at https://oig.hhs.gov/fraud/report-fraud/.
June is also Elder Abuse Awareness Month and on June 15 World Elder Abuse Awareness Day (WEAAD) is commemorated in America and worldwide. The goal of WEAAD is to raise awareness about the millions of older adults who experience elder abuse, neglect, and financial exploitation. As many as 1 in 10 older Americans are abused or neglected each year, only 1 in 14 cases of elder abuse ever come to authorities’ attention.
Here are the eight most common forms of elder abuse:
- Self-Neglect – Refusal or failure to provide himself/herself with adequate food, water, clothing, shelter, personal hygiene, medication (when indicated), and safety precaution.
- Physical Abuse – The use of physical force that may result in bodily injury, physical pain, or impairment; or any physical injury to an adult caused by other than accidental means.
- Neglect by Others – Failure to provide the basic care, or services necessary to maintain the health and safety of an adult: this failure can be active or passive.
- Sexual Abuse – Sexual contact with a non-consenting adult or with an adult considered incapable of consenting to a sexual act.
- Financial Abuse – The illegal or unethical exploitation and/or use of an elder’s funds, property, or other assets.
- Mental Abuse – Verbal or emotional abuse includes threatening significant physical harm or threatening or causing significant emotional harm to an adult through the use of: derogatory or inappropriate names, insults, verbal assaults, profanity, or ridicule; or harassment, coercion, threats, intimidation, humiliation, mental cruelty; or inappropriate sexual comments.
- Abandonment – the desertion or willful forsaking by anyone having responsibility for care.
- Isolation – Preventing the individual from receiving mail, telephone calls, or visitors.
If you suspect any form of elder abuse or neglect, you can contact Adult Protective Services at 855-444-3911 to report.
For any questions around aging and disability, please contact Region IV Area Agency on Aging’s Info Line at 800-654-2810.
Sara Duris is the Professional Referral Specialist on the Information & Access Team at Region IV Area Agency on Aging. The Generations column appears each weekend in The Herald-Palladium.