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Friday, October 21, 2011
By John D. Doak, Oklahoma Insurance Commissioner
Medicare open enrollment has begun, bringing with it both the opportunity for seniors to tailor their coverage to their needs and budgets and the opportunity for dishonest people to prey upon those seniors and the taxpayers who contribute to the program.
Fraud is an issue that Medicare continually struggles to address. The federal government estimates taxpayer losses to Medicare fraud at between $60 billion and $90 billion annually.
Seniors fear fraud, and justifiably so. One Harris Poll a few years ago showed that the greatest fear for 37 percent of senior citizens was fraud – ahead of personal health crises and terrorism.
In Oklahoma, Medicare fraud is combated by the Senior Medicare Patrol here at the Oklahoma Insurance Department. The SMP department receives complaints about Medicare fraud from consumers and trains community volunteers to help their friends and neighbors identify Medicare fraud.
The Senior Medicare Patrol is necessary because we know that Medicare fraud and waste do happen in Oklahoma. Some waste is attributable to human error – a procedure is inaccurately coded into the system, or a test is accidentally billed twice. These mistakes can and should be caught and corrected.
But all too often, billing problems are an intentional attempt to defraud the system. In one recent case, an Oklahoma man who operates a prosthetic-device business was indicated by a grand jury on charges that he illegally obtained nearly $5 million from Medicare and more than $600,000 from Medicaid by billing the federal health programs for beneficiaries who did not have prescriptions from licensed physicians for the prosthetics he provided. It is alleged that he submitted physician names and I.D. numbers to Medicare and Medicaid in cases where physicians had never treated the patients.
Medicare fraud can ring your phone or come knocking on your door, as well. Our SMP division reports that the most common form of Medicare fraud in Oklahoma is misrepresentation of the salesperson’s affiliation. The agent either directly states he works for Medicare or at least implies that he does. This might be in the form of a statement such as, “My name is Joe Smith and I’m calling today to help you enroll in a Medicare plan for the coming year.”
Seniors should always remember – Medicare never sells anything.
While OID’s SMP program is here to provide training and support, seniors also should be aware that they are their own first line of defense against fraud. In the words of our SMP trainers, when it comes to Medicare fraud Oklahoma’s seniors should “Protect, Detect and Report.”
Other rules of thumb:
There are very stringent guidelines for how Medicare Advantage and prescription drug plans can be marketed. If you are approached by an agent or company engaging in any of the following practices, refuse to do business with them and report the contact to the Senior Medicare Patrol.
Medicare open enrollment runs through Dec. 7 this year, and besides these tips about avoiding fraud, the Oklahoma Insurance Department can answer almost any question seniors might have about the Medicare system and the enrollment process.
To ask questions or get help enrolling in a Medicare plan for the coming year, contact our Senior Health Insurance Counseling Program (SHIP) at (800) 763-2828 or online at ship.oid.ok.gov.
For any other questions or concerns about insurance in Oklahoma, contact OID at (800) 522-0071 or online at oid.ok.gov.