Winning the Lottery an Every Day Occurrence: Medicare Fraud

I would like to share a personal anecdote that I witnessed first hand that shows how Medicare fraud affects not only our pocket books, but more importantly, elderly citizens (and particularly those who are poor.

When I first began working in the area of Medicare related insurance, I was helping folks in the Dallas area with Medicare Advantage plans that were specifically designed for folks who were designated as “dual eligible” (they had both Medicare and Medicaid).

The benefits that were offered by this Advantage plan far exceeded the benefits beneficiaries received from Medicare and Medicaid. Beneficiaries could receive services, such as no cost health club membership, no cost eye ware, no cost hearing aids, rides to the their doctor, and so on.

It baffled me then, when I began to run into folks who were not even interested in this plan (or similar plans). What I began to discover was that some of the “Home Health Care” agencies that were taking care of these folks were committing all kinds of billing fraud. In some cases, they might be double billing Medicare and Medicaid for the same services, or simply lying about the amount of hours they were providing care.

None of these “under the radar” services were approved vendors by any of the big plans and as I began to discover, they ONLY served clients who were dual eligible.

These fraudulent practices were so profitable that they would actually pay the client an incentive (usually about $100 per month) to keep their services (and not switch to a plan that wouldn’t pay them).

For many of these clients, $100 a month was like hitting it big! Many of these folks were very poor and enjoyed no discretionary income whatsoever.

It was a very sad scene indeed. People were actually turning away far superior health benefits that could help them remain healthy. The value of these benefits far exceeded $100 per month. Nevertheless, I understand why they kept the cash. For many of them in abject poverty, it was like a drug. Those who committed the fraud, like drug pushers.

Those who perpetrated this crime may have “won the lottery,” but in the end, everyone else pays the price. The “least of these,” our aged and poor are those who suffer the most.

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One of the immediate effects of the new health care legislation, as it effects Medicare and reported by Kaiser Health News is as follows:

Discounts and free care in Medicare: The approximately 4 million Medicare beneficiaries who hit the so-called “doughnut hole” in the program’s drug plan will get a $250 rebate this year. Next year, their cost of drugs in the coverage gap will go down by 50 percent. Preventive care, such as some types of cancer screening, will be free of co-payments or deductibles starting in 2010.

Go to Medicare National to get your Medicare Supplement Quote.

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