Investigator gives advice on how to stop medicare fraud

EXAMPLES OF MEDICARE FRAUD Fraudsters bill for unnecessary tests, drugs and equipment Medicare fraud occurs in every corner of the health care industry, says Shimon Richmond, an official in

the Department of Health and Human Services’ Office of Inspector General. Recent frauds ran the gamut: unnecessary hospitalizations, tests and durable medical equipment; physical therapy

that never occurred; ambulance transports that never happened; and home-health products, such as portable oxygen, that never reached the patient. The cases are in a government report on

frauds for the year ending Sept. 30, 2018. Richmond singled out some worrisome areas: HOME-HEALTH CARE AGENCY FRAUD Medicare covers home health care and supplies on a limited basis as

ordered by doctors under plans they set up. Sometimes no care is delivered, but Medicare is billed and pays for the phony care. Beneficiaries might be part of the scheme, and paid $100 to

$200 a month or given noncash kickbacks — such as housecleaning services or rides to a grocery — in exchange for signing monthly forms that falsely represent visits from home-health care

attendants. PHARMACY FRAUD A crooked pharmacist and deceitful doctor in cahoots defraud Medicare with “ghost prescriptions.” The doctor writes a prescription for expensive medication and the

pharmacist pays,  for example, $50 for the document–but never dispenses anything to the patient. In another scheme, a pharmacy bills for drug refills never given to the patient, or charges

for an expensive, brand-name drug but the patient receives a cheaper generic medication. CONTROLLED-SUBSTANCE FRAUD In one scenario, a Medicare beneficiary seeking the painkiller Oxycodone,

for example, agrees with a doctor who proposes billing the insurance program for the highly addictive drug along with a host of other prescriptions. Only the Oxycodone is delivered; the

other prescriptions go unfilled but Medicare is charged for all the drugs. According to Richmond, some patients are aware of what’s happening; others are completely in the dark, not part of

the scheme.