Director, Ohio Department of Aging
Health care fraud causes consumers major financial problems. The most recent estimate is that consumers lose more than $10 billion each year to health care fraud, but it is not just about losing money - lives are at stake. Health care fraud can make you sick or hurt you. From unsafe drugs sold on the Internet as a “cure” for cancer, to wheelchair offers that try to bilk consumers out of millions of dollars for unneeded equipment, health care fraud is everyone’s concern.
Health care fraud has many faces, such as billing by unscrupulous health care providers for unnecessary services or care they did not provide, billing for products not delivered, duplicate billings and more. We all pay the price for health care fraud, errors and abuse through higher insurance premiums, increased costs for medical services and equipment and greater expenses for Medicare and Medicaid.
Health care fraud costs the United States between $80 and $160 billion a year. One dollar of every $10 spent on public insurance programs like Medicare and Medicaid is lost to fraud. According to a report from the U.S. Government Accountability Office, fraud and abuse helped to increase Medicare spending on home health care to $12.9 billion in 2006, up 44 percent from 2002. The number of Medicare enrollees using in-home services rose 17 percent during that period, to 2.8 million.
Every dollar that’s lost to fraud or improper payments is a dollar that will not go to support necessary home health care and a better quality of life for older Ohioans. Consumers play a big role in the fight against health care fraud by reporting errors and possible fraud.
The National Consumer Protection Technical Resource Center provides these simple steps consumers can take to protect themselves and their loved ones:
• Protect your Medicare number on your Medicare card. Don’t ever give it out to anyone except to your doctor or other Medicare provider.
• Never give your Medicare or Medicaid number in exchange for free medical equipment or any other free offer. Dishonest providers will use your numbers to get payment for services they never delivered.
• Treat your Medicare and Social Security numbers like credit cards. Rip up or shred your Medicare, health care papers and other important documents before throwing them away. Don’t keep mail in your mailbox for more than one day.
• Visit only your personal doctor, hospital or clinic for medical help. Only they should make referrals for special equipment, services or medicine.
• Ask questions. You have a right to know everything about your medical care, including the costs billed to Medicare.
• Use a calendar to record all of your doctor’s appointments and what tests or X-rays you get. Then check your Medicare statements carefully to make sure you received each service listed and that all the details are correct.
• Always read your Medicare Summary Notice (MSN) or health care billing statement. Your MSN is the piece of mail stamped “This is Not a Bill” that comes after you get medical care. Look for charges for something you did not receive, billing for the same thing twice and services that were not ordered by your doctor.
If you have a question about a Medicare claim submitted on your behalf, discuss it directly with your physician, provider or service supplier. If you are not satisfied with the answers you receive, call the Ohio Senior Medicare Patrol (SMP) Program, which educates and empowers people with Medicare to take an active role in detecting and preventing health care fraud and abuse. To contact your local SMP, call 1-800-488-6070.