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Oklahoma seniors urged to report Medicare fraud, abuse

Oklahoma's seniors are being encouraged to report examples of fraud and Medicare abuse to the proper authorities. The misuse of the health system costs program participants throughout nation.
BY JIM KILLACKEY Published: August 7, 2011

“Day-to-day providers can make simple errors that result in waste, but sometimes those improper billings are intentional,” said Ray Walker, director of the Senior Health Insurance Counseling Program for the Oklahoma Insurance Department.

“Patients should read their statements closely, looking for that wheelchair they didn't need or that procedure or treatment that never occurred.”

Identity theft warning

Foreign scams comprise part of the annual Medicare fraud, officials said.

Callers might tell potential victims that they need a ‘new' Medicare card, or that Medicare benefits now are being connected to the patient's bank account. “What they're really after is your bank information,” said Walker “Their stories can be very creative.”

James Crowder, a State Council on Aging member from Oklahoma City, places some of the blame for Medicare fraud squarely on how the health-care program is operated.

“I think that if Medicare payments were not so automatic, much money could be saved,” he said. “The source of any claim that is new should be checked out before money is spent. Apparently every claim is thought to be legal and honest without any investigation.

Case examples

Some local Medicare fraud cases, include:

• An orthopedic surgery group headed by microsurgeon Dr. Houshang Seradge in Oklahoma City paid $3.5 million to the U.S. government to settle Medicare fraud claims. Federal prosecutors said defendants knowingly submitted false claims for payment to Medicare, Tricare's military health benefits, and the Federal Employees Health Benefits. It was alleged defendants submitted charges for medical procedures not performed. Defendants denied liability.

• In Alva, family physician Gregory Pinegar was charged with overbilling Medicare for two prescription drugs: Procrit for cancer patients, and Remicade to treat rheumatoid arthritis. He falsified information in his patients' medical records and caused staff members to send false billing information. For defrauding Medicare, Pinegar was ordered to pay $474,000 in restitution and a $1.5 civil fraud consent judgment. He spent time in a Texas prison and permanently surrendered his state medical license.

• In the Oklahoma City area, a case is pending against two individuals who opened First Century Medical Supply, purportedly providing power wheelchairs and accessories to Medicare beneficiaries. The government alleges the pair illegally pocketed $300,000 from Medicare for power wheelchairs which beneficiaries either didn't receive, received a less-expensive motorized scooter, or received a wheelchair neither requested nor needed.

• Another pending case charges a Tecumseh man who operated Heartland Orthotic Prosthetic Lab with fraudulently obtaining $5 million from Medicare and $600,000 from Medicaid by selling expensive, computerized prosthetic limbs, when the beneficiaries actually received less sophisticated prosthetics or none at all.

Killackey is a member of the Oklahoma Council on Aging.