SMP Liaison Emphasizes Fraud Prevention on Local TV

SMP Liaison Emphasizes Fraud Prevention on Local TV

David Juberg, one of our Senior Medicare Patrol (SMP) Liaisons, emphasizes the importance of Medicare fraud prevention when speaking to a group of seniors in Inglewood, California in early March. He was featured in KCET TV’s SoCal Connected program, Ghost Clinics, a local news segment on the national epidemic of Medicare fraud. The program highlights the pervasive fraud tactics in the Los Angeles region with a particular focus on bogus clinics. These fake medical clinics reap millions of dollars from Medicare by buying or stealing beneficiaries’ Medicare numbers and doctors’ identifications and then billing for a wide array of services and equipment that are often never delivered. Many of these clinics, when visited, are found empty, abandoned or only containing boxes of files of stolen beneficiary and provider identifications.

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In his presentation, Juberg talks about the first line of defense in this national epidemic, our citizens who have Medicare. Representative of the community education and outreach work California’s SMP does throughout the state, Juberg reminds beneficiaries to protect their Medicare number and gives tips on how to detect and avoid scams. He reminds them that they have the power to collapse this whole spiraling fraud cycle. Without Medicare numbers, fraudsters have no way to bill Medicare; and without a way to bill Medicare, there’s no fraud.

Several Inglewood seniors at Juberg’s presentation had their own fraud stories to share. One fellow shared about a recent a phone call he received from someone claiming to be a Medicare representative who offered him a wheelchair. While this elder fortunately did NOT give out his Medicare number and therefore did NOT accept the wheelchair offer, the call he received is an example of the many fraud tactics circulating in our communities. Beneficiaries were reminded that Medicare does NOT call them to offer wheelchairs or other medical equipment or services. That is something beneficiaries work out with their doctors.

Although the government did recover a record $4.1 billion in fraudulent Medicare claims in 2011 (see our press release), it is still far too easy for fraudsters, once they have Medicare numbers, to get money from the Medicare system. Medicare continues to use the “pay and chase” system to pay its claims versus the predictive modeling tools used by banks and credit card companies to weed out potentially fraudulent claims on the front end. “It’s a pay system, a trust system,” says Glenn Ferry with the Office of Inspector General. “As long as the paperwork looks good on the surface, [the government] allows [providers] to bill Medicare….It is pretty much a right to bill Medicare. We want to make it a privilege,” stated Ferry. With the passage of the health care reform law in 2010 and the Administration’s focus on stopping health care fraud, Medicare currently does have several pilot programs that use similar predictive modeling tools for its own claims. (See our article on new tools to fight fraud.)

Medicare beneficiaries play an important role in detecting, preventing and reporting fraud. If scam artists don’t get Medicare numbers in the first place, there will be no fraud. As the number of Medicare beneficiaries double within the next generation, the stakes will rise. It is more important than ever for our beneficiaries to know about Medicare fraud, and how to detect, report and prevent it.

California’s Senior Medicare Patrol plays an important role in this education and invites new volunteers to join our team to help stop fraud. See our Medicare Fraud section for more information and to sign up to volunteer with your local SMP team.

Also, watch the complete TV segment, Ghost Clinics. David Juberg is featured at time marker 7:14.

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.