The federal government wants to make one million Massachusetts Medicare beneficiaries into deputies in the fight the against the systemic fraud that plagues the program.
Last year alone the government recovered $4 billion in Medicare fraud thanks to increased enforcement and recovery efforts. If seniors simply keep track of their health care, read their quarterly bills and report questionable or unnecessary charges, billions more of taxpayer dollars could be saved.
“There are 40 million Medicare beneficiaries across the country, and one million in Massachusetts alone,” said Jaye Weisman, regional administrator for the New England Centers for Medicare and Medicaid Services. “That’s, in Massachusetts alone, one million sets of eyes looking at their summary notices, and detecting (inaccuracies), and then they’re going to make a call.”
President Obama’s health care reform bill included $350 million over the next 10 years to combat fraud in the system, which will pay for new computer systems to monitor transactions and for special investigations. Weisman said the government is taking a much more aggressive approach to prevent fraud, instead of trying to chase down fake or abusive providers after the fact.
The new enforcement funds will also pay for support staff to help seniors report their findings. Right now, there are thousands of operators staffed at 1-800-Medicare to help seniors work through their statements and detect wrongdoing.
Weisman and the federal government are working with local programs called Senior Medicare Patrols to help seniors get to the bottom of fraudulent payments.
Lucilia Prates, director of the Massachusetts Senior Medicare Patrol Program, works with local senior centers and councils on aging to inform seniors about ways they can detect fraud on their own. Prates said two of the most frequent fraudulent charges are services billed but not actually given, and strange providers sending bills that seniors don’t recognize.
“Our presentation is really geared at making people become very aware of the importance of becoming vigilant health care consumers and very engaged in their health care,” Prates said. “We encourage people to document everything that happens to them in a personal health care journal, or just a notebook they may be comfortable writing in. Really look for the discrepancies in your records and the record in the Medicare summary notice, or in the doctor’s bill.
“Health care errors, fraud and abuse cost us as taxpayers billions of dollars, but most importantly, they can cost you your life, or the life of a loved one.”
Prates, Weisman and Roseanne Pawelec, spokeswoman for the Center for Medicare & Medicaid Services in Boston, who met with Daily News editors yesterday encouraged seniors either to call 1-800-Medicare or Massachusetts Senior Medicare Patrol at 1-800-892-0890 about any possible discrepancy. Pawelec said if seniors spent the amount of time looking over their Medicare statement that many do over their phone or cable bills, they would be a quite a force for good.
“Imagine the power of that, if we can get them to scrutinize their Medicare summary notices the way they look at their cable bill,” she said. “Just imagine harnessing all those folks to combat fraud.”
(Ian B. Murphy can be reached at 508-626-3964 or firstname.lastname@example.org.)
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