Medicare fraud

Seniors on Medicare fraud patrol in Miami


How to protect yourself from Medicare fraud

•  Only go to your personal doctor, hospital or clinic for medical help. Only they should

make referrals for special equipment, services or medicine.

•  Never show anyone your medical or prescription records without first talking to your doctor or pharmacist.

•  If someone calls and tries to threaten or pressure you into something, simply hang up the phone.

•  If someone comes to your door and says they are from Medicare or some other healthcare company, shut the door.

•  Do your homework and talk to your healthcare provider before buying or investing in Internet “cure-all” or “miracle” products or services.

•  Don’t keep mail in your mailbox for more than one day. People can and will steal personal information from the mailbox.

•  Rip up, shred or otherwise destroy your Medicare or other healthcare papers and other important documents instead of just throwing them away, but remember to record your doctor’s visits and prescriptions in a healthcare journal. Crooks will go through the trash.

•  Treat your Medicare and Social Security numbers like credit cards. If someone offers to buy your Medicare or Social Security number, don’t do it.

• Remember that Medicare doesn’t sell anything.

•  Follow your instincts. If it seems too good to be true, it usually is.

• If you suspect an error, fraud or abuse related to health care, gather the facts and report the situation. Florida SMP has a fraud hotline at 1-866-357-6677.

•  Always read your Medicare Summary Notice (MSN) or your Explanation of Benefits (EOB), the health care billing statement. Your MSN is the piece of mail stamped “This is Not a Bill” and comes in after you receive medical care.

Look for three things on your billing statement: Charges for something you didn’t receive, billing for the same thing twice and services that were not ordered by the doctor

To report fraud, call 1-866-357-6677.

Source: Senior Medicare Patrol handout

It’s a crime that requires no guns. It frequently goes unnoticed until after the fact, and the victims are unwitting U.S. taxpayers duped to the tune of $68 billion a year. Medicare fraud has become one of the most profitable illegal activities in the country — and South Florida is the most likely place to get fleeced.

But Joe Schwartz is on the case now, trying to change all that. The retired pharmaceutical executive joined the Senior Medicare Patrol, a national group, to help teach seniors how to educate other seniors and their caregivers about Medicare fraud, waste and abuse. In presentations at health fairs, senior centers, assisted living facilities — anywhere seniors or caregivers congregate — volunteers like Schwartz show Medicare and Medicaid recipients how to protect, detect and report scams.

“It’s a responsibility we all have, not only to ourselves but also to others,” Schwartz said. “If funds are depleted, if they’re spent on paying bogus claims, what’s going to be left for our children and even our grandchildren?”

Florida, and Miami in particular, is considered the epicenter of illegal claims against Medicare, a government insurance program that provides health care to more than 46 million elderly and disabled Americans. Though there is no recent analysis of the Florida Medicare Program, the National Health Care Anti-Fraud Association estimates that at least 3 percent of all health care spending is lost to fraud.

In Florida, there are more than 3 million Medicare beneficiaries and the estimated cost of fraud to taxpayers is $3 billion to $4 billion a year.

So Schwartz, who gives his age as “over 65,” is among a small cadre of fraud fighters who crisscross Miami-Dade and Broward counties to preach the gospel of protection. Sometimes he joins forces with Gustavo Franco, another volunteer who, at 59, is “semi-retired.” Schwartz does his presentation in English. Franco extols in Spanish. Whatever the language, the message is the same: “It’s our responsibility,” Franco said. “Fraud costs us money and it’s money that can be spent on programs we need.”

On a recent January morning, Schwartz and Franco took their show to a health and wellness fair at Continental Park in Kendall, where about 15 seniors listened attentively as they talked about different types of fraud. The two volunteers were dressed in sunflower yellow polo shirts with the Senior Medicare Patrol logo in front and a concise message printed in back: PROTECT. DETECT. REPORT. A table was packed with yellow goodie bags full of handouts, including bright red fans printed with the number of the toll-free fraud line run by Senior Medicare Patrol.

“Anybody can be a Medicare criminal,” said Franco, holding up the cover of an AARP Bulletin which featured clean-cut scammers who looked like the neighbor next door. “Don’t be fooled by appearances.”

The Senior Medicare Patrol program, funded through the Older Americans Act, was established nationally in 1995 to recruit the public in the fight of what was even then a growing fraud problem. It eventually launched in five states with large senior populations and high fraud incidence rates. Florida was one of them.

“Florida is a retirement haven,” explained Sandra Colon-Ferrer, SMP outreach consultant for South Florida, “and we have a diverse population. This is where a lot of it happens.”

There are 138 SMP volunteers in the state, including 12 in Miami-Dade and another dozen in Broward. Last year, they logged almost 3,100 volunteer hours and reached 62,816 people. The result? “We received 788 calls to the hotline that we could trace directly to one of our presentations,” Colon-Ferrer said. “That’s when you know the message is getting out.”

Volunteers like Schwartz and Franco attend training that introduces them to the complex world of Medicare and Medicaid benefits. They also learn about the different kinds of scams and how to differentiate between an actual fraud and a billing error. Statewide webinars, as well as conference calls, are offered as refreshers. These are necessary because scams are ever-changing.

One of the most common frauds involves medical equipment. In 2009, Medicare spent more than $10 billion on medical equipment, according to SMP, and more than half of that was improperly spent — either it was unnecessary or the bill was wrong. Medicare recipients can be on the frontline of prevention and detection by doing one simple thing.

“You have to read your Medicare Summary Notices or Explanation of Benefits very, very carefully,” Franco said. “That is an important first step.” Such close scrutiny helps a consumer detect if he is being billed for a service he didn’t receive.

Seniors are motivated to volunteer “because they want to do something positive or because they’ve experienced fraud themselves,” Colon-Ferrer said. “They feel they can make a difference by getting the word out.”

Makeba Huntington-Symons, the state’s SMP manager, said the program is always looking for volunteers of any age. But seniors are ideal because they have the time, the skills and the experience to understand the audience. And because they, too, are stakeholders in the Medicare program, they can evoke a feeling of ownership in those who receive government healthcare benefits.

“The idea,” she added, “is to create a more educated health consumer. We want them to know that their voice matters and that advocating for their healthcare is paramount.”

Volunteers such as Schwartz and Franco often encounter Medicare recipients who think they’re receiving “free” medical care. They shrug off the possibility of being overbilled.

“They don’t think it’s their problem and that it’s not their money,” Schwartz said. “You have to tell them that Medicare is not free, that they paid into it and if money is spent on fraud, it might mean higher premiums and reduced benefits. We’re talking billions here.”

That gets their attention. “No one wants to be ripped off.”

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