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Seniors Helping to Root out Medicare & Medicaid Fraud

Senior citizens are uniquely familiar with the large healthcare programs Medicare and Medicaid. Medicare in particular is available only for seniors. Alternatively, Medicaid is based on financial need–one must have assets below a set figure to qualify. Medicaid is critical for many seniors, as it pays for permanent long-term care at nursing homes, whereas Medicare does not pay for extended stays. Any way you look at it, however, these programs are critical to the health and well-being of seniors in Illinois and throughout the country.

That is why the elderly–and their family members–have a huge stake in the financial stability of the programs. Lawmakers are constantly discussing possible changes, mostly spurred by concerns about budgets. One easy way to help the budget problems is to root out fraud and ensure that all funds spent on the programs are effective and useful. Unfortunately, billions of dollars allegedly are lost each and every year as a result of mistakes and outright fraud. The losses accrue when the programs are billed for services that are not provided, unnecessary, or provided inadequately.

Training Seniors to Spot Problems
There are many different strategies to combat these errors and fraud. One of the more interesting approaches actually involves relying on seniors themselves. As discussed in a recent Bulletin story, across the country “Senior Medicare Patrol” teams are being created to spot potential fraud.

These teams are comprised of senior citizen volunteers who receive special training on closely examining their own medical bills. The idea is that the senior may be able to spot problems–including billings for items or services that were not provided. The senior reports suspicions to others who can conduct more detailed investigations to determine the seriousness of the problem. In some cases, it may only take a single senior to report a problem which leads to a larger, systematic errors (or fraud) being uncovered. In other words, if there is a problem on even one medical bill for one patient, it may be a sign of problems affecting thousands.

Those working on these fraud teams explain that millions have already been saved as a result of seniors identifying problems. Many different types of errors are found. The story notes that “most of the calls that come through his office deal with situations where a person living in a long-term care facility mistakenly gets billed for their prescription drugs plus another resident’s drugs when the facility processes its drugs at the end of the billing cycle.”

Whistleblowers & Medicare Fraud
All Illinois seniors and their families should be aware of these fraud issues. In fact, there are laws which further incentivize residents to come forward when they suspect improper Medicare and Medicaid billings. Those laws allow whistleblowers to recover a portion of funds recovered. Considering that some cases of fraud involve tens or hundreds of millions of dollars,there are significant funds at stake. Be sure to speak with a whistleblower attorney to learn more about your options.

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