Addressing Medicare Fraud

Can individuals really make a difference in the effort to recover money that scammers have stolen from the nation’s coffers? This question recognizes that health care fraud impacts individuals and the nation. As detailed below, vigilance goes a long way in avoiding being the target of fraud and individual whistleblowers, including program beneficiaries in addition to company insiders, are crucial in helping the government recover lost funds. With offices in San Francisco, Oakland, and Sacramento, The Brod Firm is dedicated to helping prevent Medicare fraud, serving as a law firm for Medicare fraud victims nationwide.

Medicare Fraud and Individual Beneficiaries: How it Can Harm You, How You Can Fight It
healthcash.jpg Medicare fraud can harm individual beneficiaries in a number of ways. Scammers can deplete allotted services so that things like physical therapy and durable medical equipment are not available when needed. Fraud can also result in an individual receiving inappropriate treatment, such as providing medication for conditions that the patient does not have (which may carry risky side effects) while failing to treat actual health care needs. A New York Times piece from last fall catalogs some of these threats and the very real people that have been impacted by Medicare fraud.

Many cases of Medicare fraud are, in essence, cases of identity theft. Therefore, as noted on the Stop Medicare Fraud website (a collaboration between the U.S. Department of Health and Human Services and the U.S. Department of Justice), protecting personal information is key to avoiding becoming the victim of fraud. Do not give your Social Security or Medicare numbers to anyone you do not know, including groups promising “free” equipment/services or unsolicited callers (note: there is no “Obamacare” card, also avoid callers claiming you need a new Medicare card).

Another key precaution – carefully review your medical records, including your Medicare Summary Notices and Part D Explanation of Benefits. In particular, watch for services your doctor did not order, charges for items or services you did not receive, and double-billing for the same item. Never hesitate to ask questions and be wary of providers that avoid your inquiries.

How Individuals Can Help Fight Fraud on Government Programs
As for the involvement of “everyday people” in fighting fraud, it is crucial. While not parsed out to the specific types of fraud, a review of False Claims Act cases for 2012, found whistleblower suits led to the recovery of $3.3 billion. We’ve reported on some of these cases in this blog, including at least one example in which the individual who reported the fraud was a “regular” Medicare beneficiary. Notably, the whistleblowers may be eligible for significant financial rewards in addition to the knowledge that they helped tackle fraud and helped return money to the government and the honest beneficiaries who rely on the programs.

Another notable way individuals tackled fraud is via the Senior Medicare Patrol, a group of retired volunteers who help prevent and detect fraud in the Medicare and Medicaid programs. In addition to counseling individuals, SMPs nationwide were responsible for the recovery of $6 million according to a performance report https://oig.hhs.gov/oei/reports/oei-02-13-00170.asp. California’s SMP is considered the foundation of the national program and was responsible for a whopping 28% ($1,65,486) of the expected recovery of 2012 Medicare funds.

A Partner: A Northern California Law Firm Fighting Medicare Fraud
If you believe you have spotted a case of Medicare fraud, whether the scam targeted one person or thousands, call our San Francisco Medicare fraud law firm. We can help you avoid becoming a victim of fraud, recover individual damages, work towards the recovery of funds to national or state programs, and/or earn significant whistleblower rewards. You can fight Medicare fraud. We can help.

See Related Blog Posts:
Health Care Fraud & Whistleblower Suits: A $150 Million Example

Health Care Fraud Alert – Scammers Mimic Health Care Exchange Sites

(Photo by Flicker user 401(K) 2013)