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Resources
Frequently Asked Questions
As part of a growing number of retired persons in society today, you take comfort in knowing that the medical services you need will be there when you need them. The vast majority of health care professionals are honest and are trying to provide the best care they can. However, it should concern you to know that due to the unscrupulous practices of a small proportion of individuals, Medicare and Medicaid are being drained of valuable resources that you rely on when it comes to your health and the health of your loved ones.
Many people just like you are unaware of the contributions they can make to help curb and even prevent this fleecing of our medical system. By volunteering for Senior Medicare Patrols you can become an integral member of the growing effort to help fight Medicare and Medicaid fraud and abuse, and the wasting of taxpayer dollars.
What is Senior Medicare Patrols?
Announced at the 1995 White House Conference on Aging, Senior Medicare Patrols is a government-led effort which uses innovative, proactive partnerships across the federal, state and community levels to identify and report health care waste, fraud and abuse. Heading the operation at the federal level are three agencies within the U.S. Department of Health and Human Services: the Office of Inspector General; the Centers for Medicare and Medicaid Services (formerly the Health Care Financing Administration); and the Administration on Aging, which work together with the U.S. Department of Justice to combat and prevent this serious national problem.
What is the role of the Administration on Aging?
The U.S. Administration on Aging (AoA), the only federal agency dedicated to planning and delivering services exclusively to older Americans, cares about the quality of health care provided to older adults and is committed to reducing waste, fraud and abuse in the Medicare and Medicaid programs. AoA has been involved in Senior Medicare Patrols from the beginning, training state and local ombudsmen, health insurance counselors, and others to recognize and report suspected cases of fraud and abuse in nursing homes. AoA is also awarding grants to states and communities to develop public information campaigns and to train retired professionals, such as doctors, nurses, teachers, accountants, lawyers, and others to work with older Americans in their communities to review their benefit statements to identify and report potential waste, fraud and abuse.
There has never been a greater need for volunteers than there is now. Medicare and Medicaid waste, fraud, and abuse are costing our society billions of dollars. That's why we need your help. In order to better ensure quality health care tomorrow, we have to fix the problem today.
How Widespread Is Health Care Error, Fraud and Abuse?
The United States General Accounting Office estimates that $1 out of every $7 spent on Medicare is paid inappropriately due to error, fraud, or abuse. In 1999 alone, Medicare lost nearly $13 billion to improper claims.
This problem affects all Americans. It affects those who depend on Medicare and Medicaid by diminishing the quality of the treatment they receive. It affects caregivers by decreasing the funding available for important programs. And it affects everyone who pays taxes by wasting billions of tax dollars.
What Are Fraud and Abuse?
Most health care professionals are honest, trustworthy, and responsible. The goal of Senior Medicare Patrols is to weed out those few unscrupulous individuals who operate with the intention of using Medicare and Medicaid as a pipeline to personal profit. Fraud occurs when an individual or organization deliberately deceives others in order to gain some sort of unauthorized benefit. Medicare and Medicaid fraud generally involves billing for services that were never rendered or billing for a service at a higher rate than is actually justified. Health care abuse occurs when providers supply services or products that are medically unnecessary or that do not meet professional standards.
What types of activities should I be questioning?
- Providers who advertise free testing or screening.
- Offers of free medical equipment or supplies.
- Providers who offer to waive co-payments and deductibles.
- Offers of free groceries (or any other substitute) in exchange for your Medicare number or your Medicare statement.
- Door-to-door or telephone solicitors who offer free or discounted Medicare services or items.
- Advertisements that read: "Call 1-800-NUMBER; This item is approved by Medicare; No out-of-pocket expenses".
- When your Part B Medicare statement shows items or services that you did not receive.
- Suppliers that provide more expensive equipment than medically necessary (motorized wheelchairs, electric beds, lifts, etc.).
- Suppliers that provide lower cost equipment while billing Medicare for higher cost equipment.
- Medical justifications for equipment, items or supplies signed by a doctor who does not know you.
- Medical suppliers or providers that accept Medicare assignment but charge you more than the 20 percent of the Medicare-approved charge.
- Suppliers that bill Medicare for home medical equipment while the patient is in the hospital or nursing home.
- Suppliers that refuse to pick up rental items and continue to bill Medicare after you no longer need them.
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How can I protect myself from being the subject of fraud, error, and abuse?
NEVER allow anyone to convince you to contact your physician to request a procedure you do not need.
NEVER allow anyone (other than legal representatives such as ombudsmen or legal guardians) to review your medical records or prescription medications without your physician's approval.
NEVER give your Medicare number to telephone or door-to-door solicitors.
What Can I Do To Help?
First: Treat your Medicare number as you would your credit card.
Second: Read your explanation of benefits statement carefully. Call your health care provider if you have any questions.
Third: If you have called your provider and still continue to have questions, call the Senior Medicare Patrol Project in your state.
State/Local Contact Information
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