Medicare Fraud Up Close & Personal

[John Ranalletta]

I have a bad habit of not reviewing the claim notices from Medicare.  Tonight, I was searching for a specific claim to start an appeal and discovered a claim I had not seen from a Texas durable medical equipment dealer (maybe) for urinary catheters...ugh.  Fortunately, I don't need these.  Clerical error?  Maybe, but how did they get my Medicare #?

https://www.bmwsporttouring.com/discover/

I reported it to the Office of the Inspector General as possible fraud.  

 

Don't ignore your claims notices like I did.

 

t

[Skywagon]

I tend to ignore it too...will look more now.  Thanks John.

 

Similar thing....I was in Austin last week for MotoGP.  AMEX is my card of choice.  Got my bill and noticed two charges for charging my electrical vehicle from Austin City.  One was for $120 and the other for $90.  I called AMEX and the charges were immediately taken off.  Interesting since I dont own an electric vehicle other than my weed eater.  I don't even know anyone with an electric vehicle.  How the heck do you use $120 worth of electrons in the first place.

 

Guess I shouldn't have left my bar tab open....  I had one beer and the bill was over $400...thanks friends.

 

Since retirment....I've actually started paying attention....more, not always.

[syntorz]

Good on you for catching and calling it out. Yea, most won't even look at it. In fact, most people don't even look at their Cc or bank statements.

Similar happened to me. A simple exam and procedure correctly showed up on my med insurance statement, along with some random guys cardio ultrasound or something. I called insurance and the hospital several times and they admitted there was an error, but nobody could or would dig deep enough to fix it. My ins wound up paying it, no questions.

Another time was credit card fraud. I caught several transactions on my statement and Cc company removed the charges. I did my own digging on one transaction and found some scumbag paid his rent with my stolen Cc number. I was even able to trace it to the very building he lived. Called the PD in that city (Chicago) to complain...it would take a detective 30 minutes to find the fraudster, since WE KNOW WHERE HE LIVES (!), right down to his apartment number. Nope, apparently wasn't worth the time.

[9Mary7]

13 hours ago, syntorz said:

apparently wasn't worth the time

FWIW and not defending CPD....... the CC company is the victim and they don't prosecute unless it is a huge fraud. They make you "whole", write it off and move on. Not the way I would do it but that's the way the CC companies do it.

[Hosstage]

Think about the fraud cc companies deal with every day. Your "significant" fraud is one of 10,000 a day or more that they deal with, every day. Same with law enforcement. How can they possibly deal with even half that come thru?

Choices are made with the resources on hand, often the choice is F it, write it off, cheaper in the long run.

[scout6]

I find the places that expose us to fraud interesting.  The last one was the auto dealership.  We had Susan's car in for service.  That was the only charge on that card for the last several months.  Within 24 hours, airline tickets were purchased, and someone tried to purchase auto insurance (denied) with the card.  Another incident was when we purchased flowers for delivery in Chicago.  There was a charge for 800 dollars worth of pizza, as well as Uber delivery charges.  We check our accounts each month.  We also do a review of medical insurance payouts each month - making sure that the multiple accounts pay their portions is always interesting.  BCBS Medicare and TRI Care for Life have to be charged or they don't pay.  Lots of calls reminding providers to bill both.

[syntorz]

5 hours ago, scout6 said:

 800 dollars worth of pizza 

Now that's a real party!

[Joe Frickin' Friday]

20 hours ago, 9Mary7 said:

FWIW and not defending CPD....... the CC company is the victim and they don't prosecute unless it is a huge fraud. They make you "whole", write it off and move on. Not the way I would do it but that's the way the CC companies do it.

 

I was under the impression that the CC company, having become aware of a fraudulent transaction, would reverse the charge on the merchant, making the merchant the victim.  Is that not the case? 

[RandyShields]

8 minutes ago, Joe Frickin' Friday said:

I was under the impression that the CC company, having become aware of a fraudulent transaction, would reverse the charge on the merchant, making the merchant the victim.  Is that not the case? 

Yes, unless (1) the merchant didn't do anything wrong under the Visa or MC rules, or (2) where the credit card bank also owned the merchant processor.  Ultimately, the rules are designed to push the fraud to the first part that trusted the fraudster.

[Twisties]

What bothers me is Medicaid.  Medicaid recipients get no info at all on what's being billed on their accounts.  If a provider is fraudulently billing the patient will never know and it will never be reported.  I'm all for Medicaid, but that's absurd.  

As for credit cards, our provider has options for notifications.  I get a text every time a charge comes through.  I've only ever had one bad one that got through (several times been notified that my card has been shut down and a new one coming, but they won't ever give details).  Someone used my card to buy a prisoner pack at a prison.  LOL.