How To Protect Yourself from Health Care Fraud and Abuse

Comments Off

Information about escalating health care costs is everywhere. What consumers often fail to realize, however, is that much of this inflation is due to health care fraud and abuse. A large portion of these costly crimes are committed against seniors and directly affect the way Medicare and Medicaid dollars are spent. In an effort to combat these abuses, the Administration on Aging (AoA) has funded a grant to provide Senior Medicare Patrol (SMP) programs on a state and local level.

According to a study conducted by Harris Interactive, 37% of Americans aged 62-75 ranked fear of fraud ahead of concern for health crises and terrorism. An estimated five to ten percent of all health care expenses are due to health care fraud. Medicare alone lost more than $16 billion to fraud, abuse, and errors in 2004.

Health care fraud is an intentional deception which often results in an unauthorized Medicare or Medicaid benefit. Providers engaging in fraud will frequently bill for services or supplies that are not provided.

Any practice that is inconsistent with sound medical or business practices is considered abuse. Charging excessive amounts for services, filing claims for unnecessary services, or billing improperly are all incidents of abuse.

SMP is combating these abuses by enlisting the assistance of trained volunteers to work with beneficiaries to prevent, discover, and end fraud. The heart of the SMP program is education. Beneficiaries receive essential information about the prevalence of fraud and abuse and how to stop it.

Nationwide, SMP has over 45,000 trained volunteers and counselors. The program has already reached more than 1.8 million seniors in their communities and has played a role in the recovery or savings of over $103 million.

On the local level, the Virginia Association of Area Agencies on Aging (V4A) administers the SMP program. The association spearheads state-wide SMP outreach initiatives and utilizes the network of 24 Area Agencies on Aging to distribute educational information throughout the state. During a six month period in 2005, the V4A held over 370 educational events throughout the state, reaching nearly 15,000 beneficiaries.

This important effort not only helps seniors avoid losing money or benefits, but it also helps them to avoid the potential illnesses, injuries, and frustrations that can result from working with dishonest providers or utilizing bad equipment. In order to spot fraud and abuse before it occurs, consumers must be vigilant and informed.

Knowing what to look for and how to report suspected violations is the first step toward ending the abuses that are damaging our health care system. Informed consumers are a powerful defense against unnecessary spending and unscrupulous providers.

Medicare or Medicaid beneficiaries who suspect that they have been the victim of fraud or abuse should call 1-800-938-8885 (in Virginia only).

Comments are closed