In the State of Connecticut, the Department of Aging and Disability Services provides assistance and training on the issues of Medicare fraud through the Senior Medicare Patrol. The Senior Medicare Patrol “empowers and assists Medicare beneficiaries, their families, and caregivers to prevent, detect, and report health care fraud, errors and abuse through outreach, counseling and education.” In the United States, it is estimated that Medicare loses 60 billion annually to health care fraud.
According to the Department of Aging and Disability Services, health care fraud “occurs when services provided to beneficiaries are deliberately misrepresented, resulting in unnecessary cost to the program, improper payments to providers, or overpayments. Medicare fraud generally involves billing for services that were never rendered or billing for a service at a higher rate than is actually justified.”
Fraud can include poor quality of care for patients, such as billing a full hour for physical therapy services of Medicare patients while only providing service to the patient a fraction of the time. Additional examples for health care fraud include:
- Billing for services never performed, medical equipment, supplies not ordered; or billing for services or equipment that are different from what was provided.
- Double billing – charging more than once for the same service.
- Upcoding – billing for a more expensive or covered item when a less expensive, non-covered item was provided.
- Unbundling – billing related services separately to charge a higher amount than if they are combined and billed as one service or group of services.
- Falsely claiming that services are medically necessary when they are not.
- Using another person’s Medicare card to get medical care, supplies, or equipment.
Connecticut’s Senior Medicare Patrol is able to provide one-on-one counseling and assistance to those on Medicare, including teaching individuals how to prevent, detect, and report health care fraud.
Read more at Connecticut’s Senior Medicare Patrol website.
Register for AARP Fraud Watch Network’s: Fraud Fighting Fourth Fridays with Erin Soli, Statewide Coordinator for the Senior Medicare Patrol Program (SMP), and SMP Coordinator from SWCAA Lisa Alhabal – October 23, 2020 @ 10:00 am.