Part I – Medical Frauds
Since I feel pretty insecure about my own abilities to even converse with those of the younger generation about computers, tablets, smartphones, and even smarter wrist watches, I got to thinking that maybe I should look into how to protect myself from the nefarious folks that pick us Silvers to prey upon.
When I started thinking of all the areas that are potentials for defrauding us, I was overwhelmed with the sheer volume available to crooks. But first let’s think about why they choose us as a target rich environment.
The FBI tells us that we are particularly selected by thieves and con men for the following reasons:
We Silver Lifers usually have excellent credit and have access to a relatively large amount of cash in the form of our retirement funds. Couple that with the fact that we, as a group, are pretty polite and pretty trusting.
We also tend to not report a fraud either through ignorance of where to report it, or because we may think our younger relatives will take that as a sign we cannot care for ourselves. And even when we do report we often make poor witnesses who tend to be unable to provide the good, detailed information investigators need. We may even not be aware of the fraud for a long time and by then it is way too late for the police to act.
With this quick background on our vulnerabilities, I want to start this series with the general area of Fraud in the medical/health care arena.
Medical Equipment Fraud
We’ve all seen the ads on television offering us a range of equipment to make our lives easier and/or alleviate various aches and pains. These range from braces for joints and back, canes that are magically more stable, up to motorized wheel chairs and stair climbers.
When the manufacturer offers them to us “free” it means that they will bill your insurance company or Medicare directly on your behalf.
What they don’t tell us is that: a) the product may not work at all; b) the product is costing many times what a similar and more durable product would cost if your physician prescribed it for you and you purchased it from a reputable, local source; or c) the product may not ever be delivered to you.
The same sort of scheme is often disguised in the “Rollin Lab” scenario. You may have seen these (I’m not talking about the mobile blood banks the Red Cross and others use) at a retirement home, a shopping mall, or even your health club.
The owners tend to try a mild scare tactic to get you to take tests that are often not needed or can be provided by your own trusted health care provider. When you fall for this pitch, they also bill your insurance and Medicare for the service and you end up with fairly useless information that can easily be obtained in your own annual exam.
Often schemers will bill insurers for treatments and services that you never had. They can do this by either changing your bill or just submitting bogus bills.
We are all aware of the increased cost of our prescription drugs. Since this is a particularly sensitive area that can consume a large amount of our monthly finances, this is an area rife for sophisticated and organized fraud in the area of counterfeit drugs. Not only does this cost money, but counterfeit drugs can either not alleviate the problem the real drug was supposed to help, but could also be dangerous of even deadly.
I will quote the FBI guidelines for avoiding being a victim of this dangerous fraud below:
Tips for Avoiding Counterfeit Prescription Drugs
- Be mindful of appearance. Closely examine the packaging and lot numbers of prescription drugs and be alert to any changes from one prescription to the next. Consult your pharmacist or physician if your prescription drug looks suspicious.
- Alert your pharmacist and physician immediately if your medication causes adverse side effects or if your condition does not improve.
- Use caution when purchasing drugs on the Internet. Do not purchase medications from unlicensed online distributors or those who sell medications without a prescription. Reputable online pharmacies will have a seal of approval called the Verified Internet Pharmacy Practice Site (VIPPS), provided by the Association of Boards of Pharmacy in the United States.
- Be aware that product promotions or cost reductions and other “special deals” may be associated with counterfeit product promotion.
All of these above and more, mean that Medicare or insurance fraud is likely involved.
You may be tempted to shrug your shoulders and say “so what, there’s lots more money where that came from”.
In an article in the Economist, the authors tell us the huge scope of this crime:
“Health care is a tempting target for thieves. Medicaid doles out $415 billion a year; Medicare (a federal scheme for the elderly), nearly $600 billion. Total health spending in America is a massive $2.7 trillion, or 17% of GDP. No one knows for sure how much of that is embezzled, but in 2012 Donald Berwick, a former head of the Centres for Medicare and Medicaid Services (CMS), and Andrew Hackbarth of the RAND Corporation, estimated that fraud (and the extra rules and inspections required to fight it) added as much as $98 billion, or roughly 10%, to annual Medicare and Medicaid spending—and up to $272 billion across the entire health system.”
Maybe this is no big deal to you directly, but what if all that thefts were stopped and premiums reduced for you?
Again I quote the FBI in their tips for avoiding Medicare and Insurance fraud:
- Never sign blank insurance claim forms.
- Never give blanket authorization to a medical provider to bill for services rendered. Ask your medical providers what they will charge and what you will be expected to pay out-of-pocket.
- Carefully review your insurer’s explanation of the benefits statement. Call your insurer and provider if you have questions.
- Do not do business with door-to-door or telephone salespeople who tell you that services of medical equipment are free.
- Give your insurance/Medicare identification only to those who have provided you with medical services.
- Keep accurate records of all health care appointments.
- Know if your physician ordered equipment for you.
After the death of my father, my wife, who is a human resources executive, reviewed all his healthcare paperwork and found numerous incidents of fraudulent billing. The one that comes to mind is that Dad was billed for physical therapy several times after his death.
This can and does happen to us and to our loved ones. Each of us has to be prudent in our health care expenditures without compromising our health needlessly. To do so, both stops these and other kinds of fraud and theft, but also keeps us from needless and dangerous expenditures from our retirement resources. Be an educated consumer in all areas including,and especially, health care matters.