Medicare fraud!

[Plantman]

Received a statement from Medicare in the mail yesterday. It showed some medical supplies company billing my wife's account for 6 months worth of catheters. She has never used a catheter. We didn't receive any catheters. The cost of these catheters was $2250 per month! Over 13 thousand dollars and it was approved by Medicare! I had no idea catheters were so expensive. Anyway, I reported it to Medicare and her supplement company. I guess it could be a very lucrative business especially if people aren't reviewing their Medicare billing statements.

 

[Sarah S]

Sadly this was a huge scam. Glad you caught it and reported it

 

[braumeister]

Good job!
Fortunately, Medicare at least makes it fairly easy to report such fraud.

 

[MichaelB]

Let’s hope the villains are caught and pay for their crimes.

While handling my mum’s health insurance I discovered inappropriate charges multiple times. I always reported to Medicare and her insurer. Twice they could be connected to someone in her assisted living facility.

 

[rk911]

Received a statement from Medicare in the mail yesterday. It showed some medical supplies company billing my wife's account for 6 months worth of catheters. She has never used a catheter. We didn't receive any catheters. The cost of these catheters was $2250 per month! Over 13 thousand dollars and it was approved by Medicare! I had no idea catheters were so expensive. Anyway, I reported it to Medicare and her supplement company. I guess it could be a very lucrative business especially if people aren't reviewing their Medicare billing statements.

By Medicare Statement do you mean the Medicare Electronic Summary Notices?

 

[jazz4cash]

Any chance this was some clerical error or glitch? A system that allows orders for a 6 month supply seems to be inviting fraud. When I review insurance company EOB statements I feel unqualified to determine if the provider is billing properly. I recall getting one that said “surgery” and I was baffled but then I remembered going to urgent care for a splinter that we couldn’t dig out at home.

 

[Plantman]

By Medicare Statement do you mean the Medicare Electronic Summary Notices?

Snail mail statement.

 

[Plantman]

Any chance this was some clerical error or glitch? A system that allows orders for a 6 month supply seems to be inviting fraud. When I review insurance company EOB statements I feel unqualified to determine if the provider is billing properly. I recall getting one that said “surgery” and I was baffled but then I remembered going to urgent care for a splinter that we couldn’t dig out at home.

One person at Medicare said there's a chance that it's a mistake but I received a statement a couple months ago for the same bill and it was marked under review. This time it was approved and paid.

 

[harllee]

I had something similar happen. Medicare issued me a new card with a different Medicare number. It was a pain to have to give all my medical providers my new number and things were confused for a while with claims being denied. A mess.

 

[CincyDave]

That's awful. So this medical supply company got your wife's Medicare info? You'd think it would be easy for Medicare to go after them since they know who billed it, but it may cost them more than what they were defrauded for. Plus, it is the gubmint, so there's that.

 

[Koolau]

Yeah, unfortunately, gummint fraud is low risk/high reward crime. The news is full of such things and MC is not immune. Sad, really but a reality when billions are floating around in the ether.

Keep us posted, please.

 

[Murdock75]

Received a statement from Medicare in the mail yesterday. It showed some medical supplies company billing my wife's account for 6 months worth of catheters. She has never used a catheter. We didn't receive any catheters. The cost of these catheters was $2250 per month! Over 13 thousand dollars and it was approved by Medicare! I had no idea catheters were so expensive. Anyway, I reported it to Medicare and her supplement company. I guess it could be a very lucrative business especially if people aren't reviewing their Medicare billing statements.

DW was being charged for glucose monitoring equipment by a DR. and medical device company 1000 miles away and she has never been diabetic. Knew there was a problem because they didn't bill anything through her BCBS supplement. Unfortunately the person she explained this to responded with "So what's the problem." She explained it three more times and the Medicare Person hung up the phone! She had to call the company we buy our insurance through and they took care of it.

 

[Exchme]

For your own protection, I would assume that you are the victim of ID theft. BCBS had a major data leak a year ago, so your SSN and name may be available to scammers, so the medical folks involved may be victims too. I had an unemployment claim made in my name that I believe to be the result of the BCBS data leak. Freeze your credit and look for any new credit activity as scammers may not stop with just one attack.

 

[CincyDave]

Got a medicare summary notice today with six $1800 charges for catheters. Billed by Gpaak Equipment out of Texas. Reported to Medicare fraud unit who indicated they are aware of this company and are currently investigating. Summary notice indicated the charges were not approved. Just worries me that my medicare number has been compromised.

 

[Pluperfect]

Reported to Medicare fraud unit who indicated they are aware of this company and are currently investigating.

I remember hearing about catheter fraud a couple of years ago. And companies are still trying it?!? Geez.

 

[hesperus]

Received a statement from Medicare in the mail yesterday. It showed some medical supplies company billing my wife's account for 6 months worth of catheters. She has never used a catheter. We didn't receive any catheters. The cost of these catheters was $2250 per month! Over 13 thousand dollars and it was approved by Medicare! I had no idea catheters were so expensive. Anyway, I reported it to Medicare and her supplement company. I guess it could be a very lucrative business especially if people aren't reviewing their Medicare billing statements.

That is a massive amount of money for something she never even used. It’s a good thing you checked those statements, because most people just file them away without looking.

$13,000 for catheters is insane. It makes you wonder how many millions are being drained from the system like this every year. Good on you for reporting it immediately.

 

[Pluperfect]

A mere one week after I marveled that companies are still engaging in catheter fraud, I was looking over a friend's MSNs and there it was. On the MSN, Medicare approved the first four (they were billed monthly) but denied the next two (reason: The provider of this service is not eligible to receive Medicare payments.).

Also, the Medicare-approved amount was the same as what the provider billed. You'd think that would raise some red flags.

 

[hesperus]

Received a statement from Medicare in the mail yesterday. It showed some medical supplies company billing my wife's account for 6 months worth of catheters. She has never used a catheter. We didn't receive any catheters. The cost of these catheters was $2250 per month! Over 13 thousand dollars and it was approved by Medicare! I had no idea catheters were so expensive. Anyway, I reported it to Medicare and her supplement company. I guess it could be a very lucrative business especially if people aren't reviewing their Medicare billing statements.

That price alone is a red flag. Nobody suddenly needs months of supplies they never received. We had a weird billing entry show up for my mom and it took persistence to unwind, but once flagged it stopped. I remember looking for answers and finding this medicare fraud program, which helped explain why agencies ask for detailed reports and copies of statements. It’s slow, but they do track this stuff when enough data lines up.