By Rick Banas of BMA Management, Ltd.
Although he was doing nothing more than cutting a patient’s toenails, a podiatrist was billing Medicare for foot surgery. When the patient actually needed foot surgery, Medicare denied coverage because their records showed the surgery already had been performed.
When an older adult requested Medicare coverage for a wheelchair he needed, he was denied coverage. A durable medical equipment company had fraudulently billed Medicare for a wheelchair in his name so Medicare records showed that his need had already been met.
A home health agency told a woman on Medicare that her doctor wanted the agency to monitor her blood pressure. The problem was that the doctor had never talked with the home health agency let alone ordered the home health agency to perform the blood pressure checks.
Medicare fraud costs us more than $60 Billion a year, declared a report on “60 Minutes” in October 2009.
Fraud by providers and suppliers of health care services also can impact the ability of those on Medicare to receive coverage on a timely basis.
Medicare recipients must pay attention to their Medicare Summary Notices, urged Tonya Banks at the program on “How Seniors Can Protect Themselves from Scam Artists and Deceptive Practices” that was held earlier this week at the Heritage Woods affordable assisted living community in Yorkville, Illinois.
Tonya is with Senior Services Associates, Inc., a non-profit agency that serves seniors and their families in Kane, Kendall and McHenry Counties.
The Medicare Summary Notice says “THIS IS NOT A BILL,” notes Bank.
The notice shows all of the services or supplies that providers or suppliers have billed to Medicare on your behalf in the past three months. It details the nature of the services or supplies, what Medicare paid, and what you may owe.
While the Medicare Summary Notice is not a bill, you need to carefully review the summary, Bank cautioned. Be sure to verify that the name and address are correct. Also, be sure to verify that the date of service and what was provided is correct and that providers are not billing for the same thing twice.
If any of the information is wrong, you need to report it. Sometimes, incorrect information is simply the result of a clerical error that needs to be fixed. Other times, fraud might be involved.
If it appears to simply be a clerical error, you can contact your doctor’s office. To report all other incorrect information on your Medicare Summary Notice, you should contact a Medicare Customer Service Agent.
The consequences of not reviewing your Medicare Summary Notices and making sure to report any errors can be significant, Banks said. Medicare assumes that you received the services provided as indicated in the Notice and may deny coverage until errors have been resolved. She cited the stories about the women needing foot surgery and the man needing a wheelchair as examples.
If you have any questions or concerns, you do not have to wait for the Medicare Summary Notice to be mailed to you. You can check the information on-line at MyMedicare.gov.
Banks also urged older adults to maintain a Personal Health Services Journal, using the Journal to document who you saw for what and when and what medications you are on. You can then compare the information documented in the Journal with the information in the Medicare Summary Notice.
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