Medicare Fraud: Can a Senior Become a Victim?

By Lillian L. Hyatt, MSW, Resident of a CCRC and AARP Policy Specialist on CCRCs

If a senior suspects that they are a victim of Medicare fraud, to report this you start by calling the federal Health and Human Services Office of the Inspector General at (800) 447-8477. The website that gives you more information can be found www.stopmedicarefraud.gov/aboutfraud/index.html.

My motivation for writing this column on Medicare fraud is to alert victims of health care providers that are more interested in profits and their bottom line.

I want to relate my own personal experience on how I know that seniors can be made to accept treatment they do not want or need. The professional staff person knows that if they can get a senior to sign the papers presented then they are assured payment from Medicare.

In my facility there is an outside company providing rehabilitation services to residents. In February, I requested that a wheel on my walker—which was in danger of falling off—be repaired by the staff employed by this outside for-profit company. The physical therapist, instead, contacted my doctor without consulting me and obtained permission to evaluate me and prescribe exercises.

As is customary in today’s world, no one can speak to doctors any longer, only their administrative assistants. I was asked to sign papers, before I understood what was going on, that allowed for an evaluation I never wanted and exercises I could never perform.

Subsequently, Medicare was charged as well as my supplemental insurance coverage. This information reached me in July. When I protested, the employees refused to tell me the name of the company executive that supervised what they did. When I did speak with the executive, I explained why I was upset.  I was given an explanation of why legally these employees could not repair my walker. I mentioned my concern about the evaluation I never asked for and the charges made to Medicare and my supplemental insurance.

When I continued to question the entire process, I was told, “I will answer no more of your questions.”

The executive told me that the money was returned to someone in my facility. To date, I cannot discover which employee at my facility got the money, but I will continue to ask questions about this until I get some answers.

The sum billed to Medicare and my supplemental insurance was $473. My request was for the staff to repair a wheel on my walker before I hurt myself.  But that service could not be billed to Medicare or my supplemental insurance.

To sum up, a senior must be wary of signing any papers presented by rehabilitation staff, which I did because I felt bullied into doing so.

Social workers who work with the elderly should be aware that they must protect the elderly in CCRCs from being coerced into the sort of situation I describe in this column.

There are still three unanswered questions with respect to my recent experience.

• Why did the executive of the company providing rehabilitation services in my facility return the $473 to someone in my facility instead of returning it to Medicare and my insurance company?

• Who received the money?

• Why was the executive unwilling to tell me, and why will no one I ask at my facility tell me?

I was told the whole financial matter was a “miscommunication.”

As in the Nixon Watergate cover up, we will continue to follow the money. Stay tuned.

Professor Hyatt is an AARP California policy advisor. Professor Hyatt can be seen on YouTube on the USC School of Social Work website at https://www.youtube.com/watch?v=CMrC6o6Rm04