SMP Reports Recent Fraud Case Successes

SMP Reports Recent Fraud Case Successes

As Medicare fraud is a hot topic in California, our Senior Medicare Patrol (SMP) is continually receiving and resolving complex cases.

Below is a quick glimpse of a few recent cases our SMP team has successfully resolved.

If you or someone you know has a question about fraud or would like to report fraud, contact our SMP office at 855-613-7080. Also visit our Medicare Fraud section to learn more and find information on becoming an SMP volunteer.

Location Situation Resolution with SMP
 

San Bernardino County

 

A beneficiary has a durable medical equipment (DME) supplier that refuses to bill Medicare for her supplies. The beneficiary is receiving collection letters. She takes this case to and they have been working on it since Nov 2011.

 

 

This beneficiary contacts her local HICAP. HICAP and SMP work on the case together. SMP contacts the DME executive offices. Their Compliance Department researches the case and forgives $3,811 due to “improper procedures.”

Orange County A beneficiary’s identity was stolen. She discovered several pieces of DME on her quarterly Medicare Summary Notice that she did not order. This beneficiary contacted her local HICAP and HICAP and SMP work on the case together. The DME supplier claims they made a mistake and reimburses Medicare $561.17.

 

Ventura County A beneficiary has surgery and his doctor requests that he sign an Advanced Beneficiary Notice (ABN) for an assistant charge of $250. Beneficiary signs the ABN. Medicare says only 5% of these surgeries (of the type the beneficiary had) would even need an assistant, that the ABN is unnecessary, and the beneficiary is not responsible for that $250 payment. The doctor, however, continues to bill this beneficiary. The beneficiary contacts HICAP, and HICAP refers the case to SMP. SMP contacts this doctor’s billing office, but the billing office is adamant that the beneficiary signed the ABN and should therefore pay the $250. The doctor’s billing office finally forgives the $250 but informs the beneficiary that he is no longer a patient there.

 

 

Our blogger Karen J. Fletcher is CHA's publications consultant. She provides technical expertise, writing and research on Medicare, health disparities and other health care issues. With a Masters in Public Health from UC Berkeley, she serves in health advocacy as a trainer and consultant. See her current articles.