BANGOR, Maine — The best weapons for fighting Medicare fraud are the seniors and disabled who benefit from the health care program, officials told a group of Bangor seniors Wednesday.
An estimated $15 billion to $60 billion per year is spent on fraudulent claims, according to Susan Waddell, a special agent in charge with the U.S. Department of Health and Human Services office in Boston. It’s a hard number to pin down because the vast majority of health care fraud goes unreported, she added.
“That’s all money that should be going into the program for folks who really need it,” said Raymond Hurd, acting regional administrator for the Centers for Medicare and Medicaid Services.
Waddell and Hurd were joined by Michael Miller, an assistant attorney general and director of the Maine Health Care Crimes Unit, and Betty Balderson, statewide coordinator for Maine Senior Medicare Patrol, at the Hammond Street Senior Center to educate seniors about how to keep their identities — and the program — safe from fraud.
Penobscot County Sheriff Glenn Ross and Chief Deputy Troy Morton, as well as representatives of local senior support organizations, also attended the event.
There are about 50 million Medicare beneficiaries in the United States and about 286,000 of those beneficiaries are Mainers, according to the Centers for Medicare and Medicaid Services. CMS receives more than 5 million claims from its beneficiaries each day.
Hurd said CMS monitors those claims with its computer systems, which flag unusual claims in much the same way that credit card company systems warn customers of suspicious purchases under their account.
In 2012, the federal government recovered just $4.2 billion, tens of billions of dollars short of what the government loses to Medicare fraud each year.
The fraud stems from a small minority of dishonest doctors’ offices, medical practitioners and suppliers who overbill Medicare recipients for procedures, bill them for procedures they never had, or bill them multiple times for the same procedure in attempts to suck more money from Medicare coffers, according to Hurd.
Fraudulent claims often go unnoticed because recipients who read their Medicare summary notices months after their doctor visit don’t examine the documents closely or don’t remember the details of what happened during the visit, Hurd said.
The officials told the seniors to carefully examine their claims reports to look for any discrepancies, which could range from an isolated billing mistake to evidence of widespread fraud by a practitioner.
If a patient notices an isolated discrepancy on their Medicare report, they first should contact the health care practitioner to make sure it wasn’t a simple mistake. If the problems persist or the practitioner isn’t responsive, the beneficiary should report the errors so agencies can investigate for potential fraud.
Seniors also were warned not to reveal their Medicare identification number over the phone.
There is a black market of sorts for Medicare identification numbers, which match a beneficiary’s Social Decurity number. “Fishers,” often posing as Medicare or Medicaid representatives, call beneficiaries and ask for their identification numbers.
Hurd said no Medicare representative would have reason to ask for an identification number, unless the beneficiary is the one to initiate the call.
The fact that Social Security numbers are identical to Medicare identity numbers presents a grave identity security concern for some, including Norm Rivard of Glenburn, who attended Wednesday’s event. Rivard had his identity stolen three years ago and the “crooks” are still attempting to take out credit cards and make purchases in his name, despite efforts by him and credit card companies to stop them.
The speakers provided brochures and reading materials, as well as personal health journals to help the seniors keep track of their visits to the doctor and what procedures they underwent.
“I’m really counting on you to carry this beyond just this room,” Hurd told the seniors, “because beneficiaries are our strongest line of defense.”
Anyone who thinks they might be the victim of Medicare fraud may call 800-Medicare or their local Area Agency on Aging at 877-353-3771.