By Camilita Aldridge
SHINE Program Manager
Area Agency on Aging For Southwest Florida
Medicare fraud is in the news again, serving as a reminder that everyone over the age of 65 should understand how to fight against fraud, waste, abuse and dishonest practices.
Medicare fraud and abuse cost taxpayers billions of dollars every year. In fact, the Centers for Medicare and Medicaid Services estimates that $60 billion is lost to fraud, waste, abuse and improper payments in a single year. That’s $60 billion in taxpayer dollars that were meant to assist senior citizens with their medical needs.
Combatting the growing problem of Medicare fraud is the main goal of the federal Senior Medicare Patrol program, which is funded by the U.S. Administration for Community Living. Here in Florida, Senior Medicare Patrol is part of the SHINE (Serving Health Insurance Needs of Elders) program. SHINE is a free program of the Florida Department of Elder Affairs, offered locally through the Area Agency on Aging for Southwest Florida.
As part of the Senior Medicare Patrol, our motto is “protect, detect, and report” as we empower and assist older Floridians who could become victims of Medicare scams and health care fraud.
You can protect yourself by never sharing your Medicare number with strangers, or to anyone calling you on the phone or selling medical equipment door-to-door. Exercise caution by shredding your personal documents before disposing of them. And empty your mailbox every day — do not leave personal information out where anyone can steal it.
There are also easy steps that seniors and their loved ones can follow to detect potential Medicare abuse. Most health care fraud involves billing for services that were not provided and double-billing. Each Medicare beneficiary receives Medicare Summary Notices in the mail. It is important to check these notices for services that you do not remember receiving, or charges for equipment or services that your provider did not order.
Keeping a calendar of your doctor’s visits and medical tests can be helpful for detecting fraud, as well. Compare the dates on Medicare Summary Notice to the dates on your calendar. If the dates do not match up, there may be reason for concern.
What do you do if something seems amiss? Report your suspicions. First, contact your health care provider about charges that do not seem right. The problem may simply be a billing error that can be easily corrected. However, if the provider is unwilling to make a correction, or if you still have suspicions, reach out to the SHINE program for assistance with reporting the issue to the proper authorities. You can reach the SHINE program by calling the Area Agency on Aging for Southwest Florida’s Elder Helpline at 866-413-5337 (866-41-ELDER). Outside of Southwest Florida, you can contact the statewide Elder Helpline at 800-96-ELDER.
SHINE can assist with other Medicare needs as well. SHINE counselors provide free, unbiased, and personalized assistance with Medicare, Medicaid, prescription drug plans and long-term care insurance. SHINE empowers seniors, their caregivers and family members to make informed decisions about health care coverage. SHINE counselors also help beneficiaries understand benefits available through Medicare, such as preventative healthcare services. SHINE can also assist low-income Medicare beneficiaries with applying for cost-savings programs.
In the long run, Medicare fraud results in higher health care costs for all of us. Fortunately, there are steps we can all take to protect ourselves, detect potential fraud and report suspected abuse of the system.