Fraud whistle-blowers cash in on reporting incentives
Citizens eligible for monetary rewards
You may soon find your Medicare patients acting like a gang of gumshoe detectives asking a lot of questions about the content of their claims and most recent bills. The reason: It may pay off for them in cold hard cash.
Starting New Year's Day, Medicare recipients and other private citizens who alert the government of suspected instances of fraud and abuse are eligible for a reward if the information leads directly to the recovery of illegal or inappropriate overpayments.
"Senior citizens are our first line of defense in the battle to fight Medicare fraud. They can be our eyes and ears in the field," said Secretary of Health and Human Services Donna Shalala when she announced the program June 3. "This is another weapon in our fight against fraud and abuse - and protecting the Medicare Trust Fund."
Authorized by the Health Insurance Portability and Accountability Act, the Incentive Program for Fraud and Abuse Information permits anyone who provides information that leads to the recovery of Medicare overpayments to collect a reward of 10% of any recovered monies, up to a $1,000 maximum reward. This is provided that the information submitted plays a direct role in revealing fraudulent activity not already under investigation by federal or state authorities.
As such, HCFA has enlisted the HHS' Administration on Aging to use its national seniors network to gather and train volunteers to identify and report potential warning signs of fraud and abuse, with special attention being paid to the activities of nursing homes and other long-term care settings, as well as interactions with personal physicians. Examples of the types of potential fraud and abuse that Medicare is urging beneficiaries and others to help spot and report include:
- billing for services that were never provided;
- billing twice for the same procedure;
- billing for a more expensive procedure than the one received;
- billing for a procedure that is not medically necessary;
- using Medicare card numbers that were obtained deceptively.
This encouragement may lead to increased phone calls to physician offices already burdened with a long list of compliance concerns.
Practices can review the guidelines Medicare is issuing to potential consumer "investigators" to get an idea of the type of inquiries to expect. According to these guidelines, patients should be suspicious if a provider makes any of the following statements to them:
· The test is free; he only needs your Medicare number for his records.
· They know how to get Medicare to pay for it.
· The more tests they provide, the cheaper they are.
· The equipment or service is free; it won't cost you anything.
Medicare also is instructing beneficiaries to be suspicious of providers that:
· Routinely waive copayments without checking on a patient's ability to pay.
· Advertise free consultations to Medicare beneficiaries.
· Bill Medicare for services the patient does not recall receiving.
· Bill Medicare for telephone calls, conferences with the family, or scheduled but not kept appointments.
· Bill Medicare for routine check-ups.
· Give the wrong diagnosis on the claim form so Medicare will pay.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content