News :: Medicare Fraud and Abuse: The Most Profitable Healthcare Crime in the U.S.

Medicare fraud and abuse cost taxpayers approximately $60 billion a year. It?s one of the fastest and most profitable crimes in the U.S. The government health insurance program that covers 46 million elderly and disabled Americans is being hijacked by opportunists preying on patients, doctors, suppliers, and lack of oversight of the system itself. According … Continue reading “News :: Medicare Fraud and Abuse: The Most Profitable Healthcare Crime in the U.S.”

Medicare fraud and abuse cost taxpayers approximately $60 billion a year. It?s one of the fastest and most profitable crimes in the U.S. The government health insurance program that covers 46 million elderly and disabled Americans is being hijacked by opportunists preying on patients, doctors, suppliers, and lack of oversight of the system itself.

According to President Obama, Medicare fraud and abuse is fueling enormous federal budget deficits. He recently explained that we could pay for healthcare reform if we could eliminate Medicare fraud, abuse, and waste altogether.

Although completely eliminating Medicare fraud isn?t entirely realistic, curbing the growing crimes could provide healthcare to many more Americans and stop lining the pockets of the individuals, crime rings, and corrupt healthcare providers that steal a huge amount of the half trillion dollars in Medicare benefits each year.

The instances of Medicare fraud and abuse are as diverse as they are widespread. One recent high-profile case involved an Armenian-American crime syndicate that stole patient and doctor identities to setup dozens of fake clinics. The operation, which is one of the largest Medicare fraud schemes in U.S. history, resulted in over $35 million in illegal billings.

In another Medicare fraud and abuse case, nine hospitals in seven states were ordered to pay $9.4 million in fines for keeping patients overnight after undergoing what is typically an outpatient back procedure. The hospitals fraudulently billed Medicare for the unnecessary services. In still another case, eight nurses in Florida carried out an $18.7 million Medicare fraud scam in which they forged patient files to make it appear that they required home health care services that they didn?t need or receive.

Although these are just a few of the many types of Medicare fraud and abuse scams occurring each year, they show the urgent need to be vigilant about preventing Medicare scams. From charging for durable medical equipment (DME) never received to using a deceased doctor?s information to continue to bill patients, common Medicare fraud and abuse schemes include:

* Advertising “free” consultations to patients with Medicare, and then recording and using their private information for monetary gain

* Offering healthcare services or DME for free in return for a person?s Medicare number for “record keeping”

* Setting up fictitious clinics with people impersonating doctors to steal private information and commit medical identity theft is another common Medicare fraud and abuse tactic

* Using real patients? data, but without their knowledge, to steal their identities

* Not adhering to the FTC Red Flag Rules that alert the carriers paying the bills

* Fraudulent billing for a wheelchair, specialized hospital bed, or other DME is also a form of Medicare fraud and abuse

* Falsifying claims for expensive procedures is another common tactic, such as the $5.8 million fraudulent HIV infusion scheme in Miami in which a husband and wife team defrauded Medicare by submitting unnecessary HIV injection and infusion claims

Remember that when fraud happens to Medicare, it happens to all of us. Don?t let your organization become a victim. Put your employees on the front line to spot Medicare fraud by hiring a healthcare fraud and abuse expert that provides “Lunch and Learn” presentations to help avoid, recognize, and respond to Medicare fraud. Visit or call 310.831.4400 to learn how to prevent Medicare fraud and medical identity theft.

How to Get Quality Healthcare at Home

Healthcare at home includes a wide range of health services that help in delaying the need for continuing nursing home care. Some of the services included in healthcare at home are skilled nursing care, speech therapy, occupational therapy and physical therapy. Other services included with in home care are providing assistance to the elderly in activities of daily living such as bathing, dressing, cooking, eating, cleaning, and monitoring of medications and treatment.

Although healthcare at home may sound the same as home care services (and it may even include some home care services), these terms refer to two different things. While home care normally includes housecleaning services, healthcare at home typically consists of services that aim to help seniors recover from an injury or illness. For this reason, those who provide health care at home are usually licensed nurses, home health aides, and therapists. Most of these individuals work for state licensed home health agencies, public health departments, or hospitals.

Quality Healthcare at Home

If you want to ensure that you’re getting quality healthcare at home, it is always a good idea to ask your friends, neighbors and aging experts about the best home health care agency in your area. Here are some of the important points you should consider to help you in your search for the best home health care agency:

-How long has it been serving in your area?

-Ask for printed brochures that define the health care services they offer as well as their costs.

-Make sure the agency is approved by Medicare.

-Ensure that the care quality they provide is certified by a national certifying body.

-If license to practice is required in your area, make sure that the agency’s license is updated.

-Because plan of care is an important aspect of home healthcare, it should be included in the services that an agency offers

-Check the availability of agency staff. It is always a good idea to hire an agency that can provide a staff round-the-clock as needed.

-The agency should know how to respect and honor patient confidentiality.

-Consider the process employed by the agency when hiring and training caregivers.

The agency should be willing to provide their clients a list of references for their caregivers to help you find out if you’re getting the right provider or not.

Even though in home care agencies are required to do a criminal background check on their providers and thoroughly screen their applicants, actual regulations will differ depending on your location. Hence, before communicating with a home health care agency, ask your local department of public health or local agency on aging about the specific laws implemented in your state.

If you don’t want to purchase healthcare at home through an agency, you can still have it by hiring an individual provider directly. In this case, it is even more crucial to screen the individual. Interviewing the home health caregiver can help you ensure that he’s the right person for the job. Prior to the interview, make a list of the particular needs that your senior might have. For instance, if the elderly patient needs help in getting in and out of bed, you might want to mention it during the interview and ask the home health caregiver you’re hiring whether or not he is able to provide that specific type of assistance. Also, request for references from the one you’re planning to hire.

Preparing Your Home Healthcare Provider

Whether you hire healthcare at home through an agency or an independent provider, it is important that you spend a considerable amount of time to prepare the person who will be working with your senior loved one. If at all possible, try to spend a day with him/her before they formally begin the job and talk to them about what’s to be expected in your senior’s daily routine. Make sure your health care provider knows some of the important things about your senior loved one, such as:

-His likes and dislikes

-His injuries or illnesses

-Signs of an emergency medical condition

-Schedule of medications

-Need for eyeglasses, dentures, walkers, canes, etc.

-Possible behavioral issues and the best ways to handle them

-Difficulties getting around (such as trouble walking or getting in or out of bed)

-Therapeutic exercises

-Nutritional needs or special dietsArticle Source: Helpers – In Home Care Toms River NJ. Our Toms River New Jersey Senior Care professionals will develop a program based specifically on the personal care needs of your family