Medicare Fraud… Do you check your EOBs?

[Bram]

We received an EOB (Explanation of Benefit) from our Medicare secondary insurance that looked sketchy. So i checked Medicare online (don’t get paper copies) and there were $3800 total carges for catheter supplies for 2 dates in May and June, none of which had been ordered nor received. Between the 2 insurers all but $139 was covered by them & that was a write off. I called Medicare & secondary insurance & reported it, Royce Medical Supply, LLC in Florida. Looking online I see that there were other reviews/reports of fraud by this company with the same number$ and types of supplies.

I don’t closely review our Medicare EOBs, but do review the secondary insurance ones as they tell me what, if anything, we would owe on a healthcare bill.
I also discovered 4 instances where Medicare had been billed & paid for home Covid-19 tests, $94 each. One was last August & the other 3 were earlier this year. One may or may not be legitimate, but I alerted Medicare to those also.
My brother recently had 3 fraud Covid-19 test Medicare charges also.

I asked the Medicare person if I should get a new Medicare #, and he said no not necessary. I think I will check our EOBs more closely.

 

[Teacher Terry]

Yes I always read them and so far haven’t received any fraudulent charges.

 

[pacergal]

Yes, I check any and all EOBs and medical bills.

 

[trumpeting_angel]

I intend to, but the digital version requires that I click on each separate visit before I know anything about it other than the date. I have twice-weekly PT, and checking every date for potentially non-existent visits is very time consuming. I wish they would make it simpler!

Of course, it’s not the only thing about Medicare that should be simplified!

 

[Midpack]

Yes I always read them and so far haven’t received any fraudulent charges.

Yes, I check any and all EOBs and medical bills.

+2. I have checked each and every Medicare charge for the four years we’ve been enrolled, checked Medicare Part A & B and Medigap Plan G, and never had any errors yet.

 

[MichaelB]

I check mine, DW’s and my mum’s. A year ago I found a bogus charge on my mum’s statement, a charge for an audiologist. My mum lives in an assisted living and has excellent hearing. I called the audiologist and asked for all the info related to the charge, such as who scheduled the appointment, who accompanied her, and what were the results. The next day she called me back to tell me there was no exam and it was an “administrative error”. Of course, that doesn’t explain how the physician got her Medicare Advantage policy info.

I notified the insurer and Medicare. There is lots of insurance fraud and one has to be ever vigilant.

 

[Gene84]

Medicare Fraud is believed to be over a 100,000 Billion Dollar problem. Medicare seems to be very slow to doing anything to police the problem. We need to demand more Medicare Oversight. Case in point. Royce Medical Supply of Fort Lauderdale had 100’s, if not 1000’s of complaints sent to Medicare by fraud victims that I know about dating back to April 2023. There were many Red Flags that should have caused them to question the claims. It appears they are one of seven companies that went from 14 total claims to over 400,000 claims in less than a year. Our supplemental insurance company alerted us to the Fraud by sending us a letter asking for more information. Our Medicare accounts were charged $40,000 for catheters in December 2023, which we don’t need and never received. Our Medicare number were hacked. YES, you should ask to have your Medicare card numbers replaced no matter what some Medicare agent may tell you. If your account has fraud charges, your Medicare numbers were sold on the Dark Web. Royce Medical Supply business began in the Fall of 2022. It now is closed. And the owner cannot be found and is believed to left the Country. In a little less than a year Medicare paid over 2 Billion dollars to the seven DME companies. Why can your for profit insurance companies have Red Flags and ask for more insurance before paying for the claim and Medicare pays the claim, no questions asked, within a week?

 

[harllee]

Last year there was a fraudulent charge on my Medicare for Covid tests for around $100, did not order them and did not receive them. I called Medicare to report it and I was on the line over 2 hours. Ridiculous it took me so long. There needs to be a better way to report fraudulent charges.

 

[Car-Guy]

Unfortunately, I see a lot of questionable charges. Some are just outright lies. Of course there is a tremendous amount of obfuscation between Medicare (government), the medicare advantage insurance companies, the billing companies and the doctors. They have things broken up "six ways to Sunday" so I don't think anyone really understands the full picture. There is very little transparency in billing (complicated by medical bill coding) and they don't want that to happen!

The DW has had some long term medical issues (and cost) over the past decade and I could write a book on the dealing with insurance and billing companies and I'd probably only be able to scratch the surface.

Whenever "this topic" comes up I think of this scene from "The Godfather.", particularly the last ~15 seconds of the clip.

 

[athena53]

Thanks for this post. My friend works for a government contractor answering calls form Medicare beneficiaries. He gets at least one call a night from someone asking about a charge for treatment they never got or about DME (Durable Medical Equipment such as a walker or other mobility aids) that they got because someone called and said their doctor said they needed them. Despite that I tend to put my head in the sand and not get on the Medicare site because I freak out at charges that are in the process of settlement (from the doc, through Medicare and then the supplement) and don't check until I get an actual bill, which rarely happens since Medicare and the supplement cover almost everything.