Seniors Advised On Medicare Notices And Fraud Protection

By Nancy K. Crevier

Eric Freedman, CHOICES counselor assisting Connecticut citizens to better understand Medicare and health care options and a Senior Medicare Patrol coordinator of volunteers, was at the Newtown Senior Center on Riverside Road, Tuesday afternoon, May 22, to discuss how to understand the information in the Medicare summary notices and how to fight fraud.

Mr Freedman stressed the various ways in which the summary notices can be misunderstood, and how easily billing or diagnosis code errors can occur. Reporting health care errors, fraud, and abuse is actually beneficial to clients, doctors, and to Medicare, he said. He provided a handout dissecting a summary notice, which is not a bill, listing the important points that should be checked for mistakes. Make sure the Medicare number on the notice is accurate, and check that the date matches the day a test was given or processed, and that the charge was for a service provided.

Look for the Medicare logo and check that the provider name and address, or medical supply company name is correct.

“But what looks like fraud often is not,” noted Mr Freedman. “The charges may be for things you are not aware of. Do you know your radiologist’s name and where they are located?” he asked the attentive group of more than two dozen Senior Center members. “The radiologist, for example, may be located in another town, or the billing service may be in another town, so the address will be different than your doctor’s,” he said.

With thousands of numbers making up billing and diagnostic codes, it is not unlikely that errors can occur, said Mr Freedman, resulting in a problem when payment is refused or overpayment is made. “Call your doctor if you think there is a mistake. The claim should be resubmitted. When the right code is entered, the problem is solved,” he said.

There is no doubt, though, that Medicare fraud does happen, he warned. Medicare fraud is easier now than 30 years ago, because a physical presence is no longer required to steal a card or get into an office. “It can be done by computer. A thief can be anyone they want now,” Mr Freedman said, and cautioned the seniors to stay alert to charges they do not recognize on the summaries. On a more positive note, he said, Medicare now is using the power of new technology to track down fraud.

An appointment information sheet was given out at the May 22 program, “Or just use a notebook,” he told the group. “Write down when, the date of your appointment, what kind of services you received, and the charge if you can find out,” he suggested. By comparing that information with the summary notice, it can be less confusing, he said.

Mr Freedman also discussed common telephone and computer scams. One in particular is aimed at older people, and one member said that she had received such a call. The call purportedly was from her grandson, who is away at college. The speaker said he had traveled to Canada and given some people a ride, who turned out to be in the drug trade. When stopped by police, they were all arrested and he was in jail. He begged her not to tell his parents and to please wire him the money to get out. When she asked how much, he told her “Thousands. I said I didn’t have that kind of money, and he hung up. It was definitely fraud,” she said, and Mr Freedman agreed.

Unfortunately, he said, these calls often are made at night to enhance the confusion, and some people do end up sending money — to people who are definitely not related. How they know a person has a grandson, Mr Freedman responded to that question, is completely random. 

“It’s a common scam. The details change, but not the final request,” he said. He reminded the audience that they have spent years developing common sense. “This is no time to lose it,” he joked. “Hang up. Take a deep breath, and think. Call your grandson. Call his parents. You have time to think about it,” cautioned Mr Freedman.

To avoid fraud, whether in Medicare or a targeted scam, it is prevention, Mr Freedman said, that is the best thing.