Fraud against Medicare and Medicaid is a growing problem that cost U.S. taxpayers over $68 billion last year. Amid growing concerns about this crime, Florida’s senior population has decided to band together in order to patrol and deter this type of misconduct. The False Claims Act is routinely implemented in cases involving Medicare and Medicaid fraud and incentivizes reporting by offering whistleblowers up to thirty percent of any amount recovered by the federal government. Cases involving Medicare and Medicaid fraud begin with the filing of a complaint in federal court, and the federal government often intervenes in the case in order to espouse the maximum possible recovery. For these Miami-area citizens, uncovering alleged Medicaid or Medicare fraud could possibly lead to sizable rewards and the elimination of waste through fraud.
Florida, particularly south Florida, is one of the hottest spots for healthcare fraud due to its extensive retirement-age population. Senior Medical Patrol, a nationwide program dedicated to its mantra of “Protect. Detect. Report,” recently gained steam in the Miami area after retired pharmaceutical executive Joe Schwartz recognized the true cost of healthcare fraud to the patient community at large.
According to Schwartz, the greatest area of abuse is fraud involving medical devices. Research suggests that up to one-half of all funds disbursed through Medicare and Medicaid for medical devices are improperly billed. Schwartz implores all patients to carefully review their Medicare Summary Notices or Explanation of Benefits in order to detect possible mis-billing with regard to devices that are not necessary or that the patient never received.
As we have previously reported, another common area of fraud involves an act known as “upcoding,” which involves billing Medicare for time with a doctor that either did not occur or occurred for a much shorter period of time than the amount reflected on the invoice. Upcoding has also involved billing for a physician’s time with a patient when the physician actually directs nurses or office staff to handle the issue. If you suspect this type of fraud, keep careful track of each visit to your doctor’s office, the amount of time you spent with the physician, and whether nurses or staff members administered any aspect of your office visit.
Schwartz further reiterated the common misconception that Medicare is a “free” service guaranteed to seniors once they reach a certain age. To the contrary, Medicare recipients have worked countless years to pay into the Medicare system. Schwartz remarked, “They don’t think it’s their problem and that it’s not their money….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.”
Using the False Claims Act to Combat Fraud
Senior Medicare Patrol is a part of the Administration on Aging and takes fraud and misspending very seriously. In order to recover lost funds, seniors (or any age group) who suspect healthcare fraud should meet with a whistleblower attorney as soon as possible. If you see certain aspects of your Explanation of Benefits or Description of Services that do not seem right to you, we encourage you to meet with one of our attorneys right away. Remember, healthcare fraud, particularly Medicare fraud, involves the intentional misuse of your hard-earned money.