Oklahoma senior citizens are being urged to recognize and report — without fear of recrimination — suspected cases of Medicare fraud and abuse.
“All of us end up paying for fraud,” said Sanford C. Coats, U.S. attorney for the Western District of Oklahoma.
“It takes critical resources out of our health care system and drives up the cost. This adversely affects the Medicare program upon which millions of Americans depend.”
Some 1.1 million Oklahomans 65 or older or disabled receive $3.9 billion in Medicare medical services annually.
In the United States, Medicare benefits are projected to reach $550 billion this year, providing health insurance to more than 48 million Americans.
Fraud on the rise
In the past three years, the number of criminal and civil cases involving Medicare fraud in Oklahoma has increased by 350 percent, according to the U.S. Department of Health and Human Services Office of Inspector General.
There have been seven criminal prosecutions and 38 civil settlements, with more are expected in the future. Federal officials report collecting settlements of $22.4 million.
Cases involve bogus companies, scheming individuals and medical practitioners who overcharge Medicare for prescription drugs, bill for services or medical equipment never received, and commit other unlawful health-care practices.
Nationally in 2010, federal authorities opened 1,116 new criminal health care fraud investigations. In addition, they filed charges against 931 defendants, secured 726 criminal convictions, opened 942 new civil health care fraud investigations, excluded 3,340 individuals and entities from participating in the Medicare and Medicaid programs, and recovered more than $4 billion.
“Most health care providers are honest and ethical,” said Coats. “Unfortunately, there are a few who choose to engage in billing fraud and abuse.”
Fraud is committed by physicians, clinics, hospitals, medical-device providers, pharmaceutical suppliers, and other health-care professionals. Also, nonmedical individuals create fraudulent companies to bill for services or equipment, or commit medical identity theft in order to receive medical benefits, buy drugs, or submit fake billings, Coats said.
State seniors are encouraged to be watchdogs and whistle-blowers.
Seniors are advised to meticulously read their Medicare summary notices and their bills from hospitals or health care providers, even if the cost already has been paid by Medicare and the paperwork isn't asking the patient for money out-of-pocket.
“I do frequently urge seniors to check over their medical reports carefully,” said John Terneus, a member of the state Council on Aging from Yukon. “While one patient's error may be small — $10 for an aspirin — the same error for 1,000 patients adds up.”
When senior citizens see something that doesn't make sense on their medical statements, they should contact the Medicare Fraud Hot Line.