What’s hospice fraud? Make sure you’re checking your Medicare statements

The week of June 5 is Medicare Fraud Prevention Week, sponsored each year by the government-funded volunteer-based Senior Medicare Patrol, whose field offices in all 50 states root out and report healthcare fraud, and run Medicare prevention outreach programs.

It is annually during that week which includes June 5, as in 6/5 for 65 years of age when many Americans retire and begin receiving Medicare benefits.

SMP estimates that Medicare loses $60 billion each year due to fraud, errors and abuse, though it said the exact dollar amount is impossible to measure.

It is also often an invisible fraud. Medicare recipients often don’t know their information has been used by fraudsters to collect payments for treatments, services and medical equipment that the victims never know were submitted to Medicare on their behalf.

One of the most concerning frauds is hospice fraud. A criminal may collect the personal information needed from a victim and submit claims for reimbursement of hospice care costs. The victim may never know, but once a Medicare recipient is classified as hospice care, they are no longer eligible for any kind of necessary curative care.

“The hospice program is for individuals to have end of life services. So, if somebody didn’t know they were signed up for hospice, then there are certain things and procedures that they can’t have dealing with their health as they are needed,” said Nicole Liebau, director at the Senior Medicare Patrol Resource Center.

Medicare only sends statements, not bills to recipients. That is why Medicare is ripe for fraud, and why it is important for Medicare recipients, or their family or caregivers, to carefully review the statements they receive.

“The bill will not come to that person. So that won’t be a red flag because Medicare covered it. It was a covered service. But it wasn’t one that they received. Understanding and being able to compare those statements that they receive to what actually happened, what appointments or what services the person really had,” Liebau said.

SMP has posted a video online about how to read Medicare summaries. It will also send patients, free of charge, a booklet for keeping track of medical appointments and services called My Health Tracker.

Other common examples of fraud are charging for supplies that were not provided, including things like motorized wheel chairs or back braces, misrepresenting a diagnosis to justify payment and prescribing or providing excessive or unnecessary tests and services.

Check out more information about SMP’s services and guides and how to contact a local office.

Senior Medicare Patrol is a grant-funded project of the U.S. Department of Health and Human Services.

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Jeff Clabaugh

Jeff Clabaugh has spent 20 years covering the Washington region's economy and financial markets for WTOP as part of a partnership with the Washington Business Journal, and officially joined the WTOP newsroom staff in January 2016.

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