RALEIGH — Stephanie Bias travels the state helping older people learn to detect and prevent Medicare fraud.
That means fighting both the multimillion-dollar operations that steal from the government, and the scam artists who take thousands right out of people's pocketbooks, said Bias, who heads the Senior Medicare Patrol within the state insurance department's Seniors' Health Insurance Information Program.
"Let's say you're a diabetic," Bias said. "You need lancets and tests and glucometers. You see a trusted figure on TV saying you're going to get all that for free. They send you enough testers to drain every drop of blood from your body. They keep sending it until the doctors tell them not to send anymore."
Even when beneficiaries ask that the unnecessary shipments stop, scam artists may keep sending them and billing the taxpayers.
How do I get involved?
Through the patrol program, volunteers learn all about avoiding, detecting and preventing Medicare fraud, then train beneficiaries and caregivers to do it for themselves.
They learn how to understand their own statements, protect their personal information, catch and report mistakes, and look for scams such as illegal marketing, providing unnecessary services, and being charged for services never supplied.
Specifically, all 750 SHIIP volunteers are being trained this quarter to look for fraud, waste and abuse, and to teach others how to do so. They've also got a brand new toll-free number for reporting fraud.
"There's a lot of identity theft and a lot of cold calling," Bias said, referring to the practice of calling numbers at random in hopes of finding a victim. "They call you and say, 'I know that you've been at the doctor in the last week for your diabetes and we just want to verify your Medicare number and your doctor's name, and we'll call him for you.'
"Our advice is, don't give your Medicare number to anyone who says they are calling from Medicare," Bias said.
Does it happen here?
Earlier this month, Dr. Janet Johnson-Hunter of Jacksonville was sentenced to 28 months in prison, fined $10,000, and told to repay Medicare more than $425,000 for fraudulent billing for ambulance services, according to federal court documents.
Johnson-Hunter had instructed employees to conceal material facts in an effort to maximize the likelihood of reimbursement from Medicare and Medicaid, specifically for ambulance transports, according to the U.S. Attorney's office.
On a smaller scale, someone actually reached the Chatham County Council on Aging, which is charged with protecting older people, during a random calling session to find scam victims.
"They ask if you have diabetes, and then tell you that a company representative can come to the home and show you a better blood testing meter," Director Angel Dennison said. "They then ask for your Medicare number and address."
How big a problem is it?
Medicare's trustees reported Friday that fraud detection recovered nearly $2 billion in 2010, with the money going straight back to Medicare. But with estimated annual fraud exceeding $60 billion, there's plenty of room for sharp-eyed community members to enter the picture.
As recipients' share of Medicare costs has risen, they are more likely to notice discrepancies or charges that don't make sense, Bias said.
"They'll say, 'Why did you pay $3,600 for a scooter I didn't need, and I had surgery that cost $25,000 and you gave me $9,000?'" she said.
The nationwide Senior Medicare Patrol reports putting more than $100 million back into Medicare since it was established in 1997. It's a drop in the bucket, even though the sum does not include potential fraud averted through education.
Still, the effort offers an opportunity for the people who have complained for years about the waste, fraud and abuse in government systems, Bias said.
"It's time for them to stand up and do something about it," she said.
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