Seniors Fight Back Against Medicare Fraud

By Kathleen Sebelius, Secretary of Health and Human Services
Posted September 20, 2012

President Obama is making unprecedented strides in cracking down on health care fraud – already over $10.7 billion has been recovered since he took office.  And thanks to the Affordable Care Act, we have even more tools to stop fraud – including more law enforcement boots on the ground and more time in prison for criminals.  We’re also using state-of-the-art technology to spot fraud, similar to what your credit card company uses .  As a result, prosecution of health care fraud cases is up 75% since 2008.

But for all of our new technology and investigative muscle, the most valuable resource we have in the fight against Medicare are the millions of seniors who serve as our eyes and ears.  Seniors who notice services they never  received on their Medicare statements often provide the first tip that fraud is happening, so we’ve redesigned Medicare statements to make them easier to read and understand.  And our Senior Medicare Patrol (SMP) programs are educating seniors, family members, and caregivers around the country about the importance of reviewing their Medicare notices to identify errors and report potentially fraudulent activity.

That’s why the Obama Administration is investing more in the Senior Medicare Patrol. Today, the HHS Administration for Community Living announced more than $7 million in new funding to support Senior Medicare Patrol projects around the country.  This investment means more seniors will learn how to stand up for Medicare and will have even more support when they suspect that something isn’t quite right.

Seniors are paying attention and they are fighting back against the fraudsters who are trying to steal from Medicare.

I heard from a Medicare beneficiary in Texas who was asked to sign a work order for his diabetes supplies.  He said that normally he would have just signed and thrown the paper away.  But he had recently heard a presentation from the SMP at his adult day center, so he looked more closely and noticed that he was being charged $7,000 for one month’s supply.  So he asked his home nurse to help him call the National Hispanic SMP and together they figured out that the supplier was going to charge Medicare for 100 boxes of diabetes test strips and 100 boxes of lancets, even though he’d received only one of each.  The SMP helped resolve the case and made sure that Medicare only paid for the supplies he actually needed and received. 

Jerry Gilman, a 68-year-old Vietnam veteran from California, has a medical condition that often makes him dizzy and in danger of falling.  His daughter, Deborah, and his doctor arranged for him to have a motorized chair to help him get around.  But the chair that arrived was not the chair that Mr. Gilman ordered.  It was smaller, flimsier, and made by an entirely different manufacturer.  Deborah called the supplier, but their hands were tied – Medicare had already processed the payment for the chair.  So Deborah turned to the SMP for help.  After weeks of investigating, they uncovered that someone had intercepted Mr. Gilman’s order and replaced it with the less sturdy chair.  The SMP was able to work with Medicare to correct the problem, get Mr. Gilman the correct chair, and make sure that Medicare wasn’t charged twice.

Chuck Johnson in Montana received a telemarketing call offering him diabetic testing supplies that he didn’t want or need.  But even though he was clear with the caller that he did not want anything, charges for those supplies showed up on his Medicare statement anyway.  Mr. Johnson got in touch with the SMP to see if they could help fix the problem.  Not only did his call mean that Medicare recovered money in his case, it also opened up a broader investigation into the organization that called him and could result in additional savings and prevented fraud. 

These three stories are eye opening, but they are not unique.  More than 1.5 million seniors have called SMP programs in cities around the country to ask questions and report potential fraud.  Together they’ve saved Medicare and the federal government in excess of $100 million.  

To all of you reading your Medicare statements carefully and tipping us off to fraud, I say thank you.  And I know your fellow American taxpayers say thank you, too. To learn more about the SMP program and to join us in our fight against Medicare fraud, go to www.stopmedicarefraud.gov.