On Friday, (July 22, 2016), the Department of Justice charged three individuals for conspiring to create a fraud scheme which billed more than $1 Billion to Medicare & Medicaid. One of the saddest parts of the story - "patients who were drug addicts were prescribed opioids - including OxyContin and Fentanyl to entice them to stay in the facilities." You can find more about the $1B case in this WSJ article.
This story made front page news this weekend, and rightfully so since $1B is a lot of taxpayer money! But, you know what is sad about this story? $1B is only 0.17% of the ~$600B spent each year on Medicare.
According to a Bank of America study (see Infographic below), Seniors (65+) spend an average of $3,450/month or ~$41,400/year.
What should you do?
This math above is not intended to downplay the fraud that these alleged individuals committed. Actually, just the opposite - it's intended to bring perspective to the massive amount of money ($600B) this country spends on Medicare each year. We should all be scrutinizing the program to ensure it lasts for generations to come.
- Review EOBS: Make sure you ALWAYS review your Explanation of Benefits (EOBs) from Medicare to ensure the services being billed are accurate. Even if you have a great Medicare Supplement and don't have to pay any of the charges, it is absolutely imperative that everyone reviews these EOB statements to ensure the Medicare providers are billing accurately for the services being provided.
- Suspicious Activity: If you ever feel that medical services being provided are not necessary, you should look to get a second opinion. If you have a gut feeling that something 'just doesn't feel right' or is 'suspicious', you should contact Medicare (1-800-MEDICARE) to report the suspicious activity. It may turn out to be a misunderstanding, but you could be helping to prevent fraud and even painful, unnecessary treatment to another individual.
I hope the DOJ continues to pursue these cases and prosecute to the full extent allowed by law. More importantly, I hope fewer and fewer individuals attempt to scam our Medicare Program in the future.