Our Job to Stop Medicare Scammers

Our Job to Stop Medicare Scammers

The April 2, 2018 issue of AARP Bulletin focuses on Medicare Fraud with a spread entitled “Medicare Under Assault” and the cover screaming that “crooks are stealing your healthcare dollars.” The article describes how medical coders and others are helping to identify and prosecute the scammers, who have figured out how to steal from Medicare by:

  • Charging for services never delivered
  • Falsifying records
  • Inflating claims/up coding
  • Stealing beneficiary’s ID
  • Filing duplicate claims and phantom billing
  • Provide unneeded equipment
  • Buy off doctors/patients
  • Shortchanging patient care

They described organized schemes in which Medicare was bilked of tens of millions of dollars at a time by criminals. Some of the criminals are organized crime organizations tapping our federal government and stealing our Medicare dollars. That should get our hackles up.

Finding the Scammers

What really concerns me, from a day-to-day perspective, is what differentiates the honest provider from these criminals? Although those looking for Medicare fraud are looking for the signs of fraud, what keeps the honest providers from getting swept up and not only having to defend their honest and hopefully compliant operations, but also divert the attention of the investigators from the really criminals who have their hands in the cookie jar?

Medical coders and billers must take responsibility to have active, breathing, and functional compliance plans in our operations. We need to identify areas of risk and correct any risky behavior before it may come to light to investigators. We need our house to be squeaky clean and beyond reproach if any investigations come knocking at our doors. You have heard how a bad apple spoils the barrel; well, these criminals make it more difficult for the honest providers to prove their compliance and honesty. This means we must make sure that our operations are beyond reproach.

If you are having a difficult time convincing your providers to commit to compliance, show them this from the AARP. Explain to them that without a strong compliance program you cannot differentiate yourselves from the criminals described in the AARP bulletin. Hopefully, this might be what they need to understand why the practice must commit to a living breathing compliance process!

New Cards Will Thwart Scammers

As part of the effort to protect Medicare money, AARP is suggesting that Medicare beneficiaries not carry their new Medicare Beneficiary Cards with their Medicare Beneficiary Identifier (MBI). They suggest a copy of the card be carried and that  beneficiaries black out some characters. So, when patients arrive and present you with their new Medicare cards with their new MBI, you may see that some of the characters blacked out and you are going to have to ask the patients to supply you with those characters.

Barbara Cobuzzi

Barbara Cobuzzi

Barbara J. Cobuzzi, MBA, CPC, CENTC, COC, CPC-P, CPC-I, CPCO, AAPC Fellow, is a consultant with CRN Healthcare Solutions in Tinton Falls, N.J. She is consulting editor for Otolaryngology Coding Alert and has spoken, taught, and consulted widely on coding, reimbursement, compliance, and healthcare-related topics nationally. Barbara also provides litigation support as an expert witness for providers and payers.Cobuzzi is a member of the Monmouth, N.J., AAPC local chapter.
Barbara Cobuzzi

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Barbara J. Cobuzzi, MBA, CPC, CENTC, COC, CPC-P, CPC-I, CPCO, AAPC Fellow, is a consultant with CRN Healthcare Solutions in Tinton Falls, N.J. She is consulting editor for Otolaryngology Coding Alert and has spoken, taught, and consulted widely on coding, reimbursement, compliance, and healthcare-related topics nationally. Barbara also provides litigation support as an expert witness for providers and payers. Cobuzzi is a member of the Monmouth, N.J., AAPC local chapter.

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