Senior Citizen's Guide to Cleveland 2013 Vol. 1 - page 20

Say You Saw It in the Senior Citizen’s Guide to Cleveland
Medicare fraud, and the crackdown continues.
The Affordable Care Act provides stiffer penalties,
better screening of providers, and more money to fight
fraud. It focuses on prevention rather than the tradition-
al “pay-and-chase” model of catching crooks after the
crime has already happened. In 2009, the Departments
of Justice and Health and Human Services established
the Health Care Fraud Prevention and Enforcement Ac-
tion Team, or HEAT. In 2010 alone, HEAT activities re-
covered more than $4 billion dollars and resulted in the
filing of 140 indictments against 284 defendants who
had collectively billed the Medicare program more than
$590 million dollars.
Sometimes it’s not only dishonest providers or mem-
bers of organized crime who commit fraud. In one case
brought to light by HEAT activities, ordinary citizens
served as “patient recruiters,” inviting people to health
fairs organized at churches and other community loca-
tions. They obtained participants’ Medicare numbers,
later paid a doctor to prescribe unnecessary medical
equipment, and then sold the prescriptions to medi-
cal equipment companies who would bill Medicare for
equipment the Medicare beneficiaries never received.
Medicare fraud hurts individuals, not just the
It’s easy to focus on the financial losses, but it’s im-
portant to remember that people can get hurt when pro-
vided unnecessary or inappropriate care just so some-
one can make more money. In one recent case, a doctor
was found guilty of falsely diagnosing patients with rare
blood disorders and ordering medications and diagnostic
tests that weren’t needed. This not only cost the Medi-
care program millions it put patients at risk. In another
example, a beneficiary living in a small town received
Medicare Summary Notices showing charges from three
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