Medicare and Medicaid fraud have been a huge contributor to high costs of health care for seniors, with both improper reimbursements and unnecessary treatments and billings. We are talking about billions of dollars in fraud. The Department of Health and Human Services is now increasing the reward for anyone who reports fraud to as much as 15% of the amount recovered up to $9.9 million (and since billions of dollars in fraud has taken place, this maximum, unfortunately, is needed). Here is their revised whistleblower reward program for those turning in companies and doctors who are fraudulently billing Medicare.
Medicare’s new fraud alert reward has been modeled on an IRS program that has returned $2 billion in fraud penalties and unpaid taxes since 2003, the Health and Human Services Department says.
Senior caregivers who feel a senior is receiving medical treatment that is unnecessary or received medical doctor invoices for services that were not performed should call the Inspector General’s hotline to report Medicare fraud.
The proposed rule would also strengthen certain provider enrollment provisions. One would allow HHS to deny enrollment of providers who are affiliated with an entity that has unpaid Medicare debt. It also would allow CMS to deny or revoke billing privileges for individuals with felony convictions, and revoke privileges for providers and suppliers who are abusing their billing privileges.
Under the proposed rule, HHS also would expand the ability of its Senior Medicare Patrol program to educate more Medicare beneficiaries about suspicious billing by providers that could be evidence of fraudulent activities. Total funding for all the 54 current SMP projects amounts to $7.3 million.
The Scooter Store has been a recent Medicare and Medicaid fraud spotlight for their laser focus on taking advantage of a high reimbursement for power wheelchairs for seniors – only they decided to give seniors cheaper scooters instead of high quality wheelchairs and even went so far as to have a network of medical doctors “approve” the senior’s need for the power wheelchair.
However, the federal government must also take some responsibility for The Scooter Store exploitation, simply because their juicy fees attracted The Scooter Store to play the fraud game. But of course the old reimbursements that were fat and juicy were due to lobbying by these groups. The Wall Street Journal investigation also exposed that home health companies received a $2,000 bonus after the 10th R.N. home visit, and guess what? The largest home health agencies always made sure they had 10 visits. This was not set-up to benefit seniors, but just another example of payments that make it into legislation due to strong lobbying.
Obama Care, as the new healthcare law has been labeled, does have some very positive aspects which include “accountability of care”. In addition, some Medicare reimbursements which were a bit unnecessary (i.e., would never survive in the private sector), were revamped.
Power wheelchairs payments were formerly paid in one lump sum by Medicare. Profits of thousands of dollars per wheelchair were pocketed by The Scooter Store immediately. As of last year, though, this changed and a more reasonable rental fee was paid for the power wheelchairs. Then The Scooter Store ran into cash flow issues and this, according to some former employees, stimulated even more aggressiveness to “get approval by a medical doctor” for a power wheelchair for a senior – going to 3 doctors or more and even coding doctors based on how difficult or easy it would be to get them to approve the wheelchair.
A whistleblower turned in The Scooter Store several years ago and this placed them under more scrutiny as they continued to push the envelope by selling power wheelchairs to individuals who did not really need one. They even sent out direct mail promotions advertising they could obtain a “Free” wheelchair for seniors.
Caregivers can help be the watchdog for Medicare fraud. As senior caregivers are involved with day-to-day care, you have the inside view of all medical care and can quickly see when something seems unnecessary. As more fraud is stopped, it is hope the senior care dollars will go towards actually paying for senior care.
