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Watch Out for Home Health Care Fraud

How to avoid or prevent billing scams

Medicare's home health care benefits and services allow many people to live independently in their homes. The program covers visits by nurses, aides, physical therapists and other medical professionals for people who are homebound, allowing them to get assistance with their most basic needs, such as bathing, dressing, house cleaning and meal preparation.

You need to make sure that you are being billed for the actual services received, however.

A Government Accountability Office report in 2009 revealed that some providers of home health care were exaggerating patients' medical conditions while others billed for unnecessary services or care they did not provide. How does it happen?

A recent case in Miami illustrates one way in which home health care fraud happens:

A privately owned company falsified medical documents to make it appear that Medicare beneficiaries needed skilled nursing services to administer insulin injections. Nurses with the group falsified medical tests and patient files to make it look as if the insulin were needed. Others in the group recruited and paid Medicare beneficiaries for their Medicare numbers. The group provided these documents to home health agencies in return for kickbacks and bribes so the agencies could bill Medicare for expensive home health services and insulin therapy.

These phony documents resulted in Medicare being fraudulently billed for about $16 million for services that were neither medically necessary nor, in some cases, received. The defendants in this case are now in prison and have been ordered to pay back Medicare. One of the Medicare beneficiaries who allowed his Medicare number to be used was also sentenced.

What you can do

• Don't give your Medicare or insurance identification number to anyone in exchange for a free gift or service.

• Give your medical identification numbers only to the medical professionals you know.

• Let only your medical professionals review your medical records.

•  Always check your Medicare Summary Notice (MSN) or insurance Explanation of Benefits (EOB) to make sure there are no claims for services you did not receive. If you see a claim for a service you didn't get, report it.

•  Report questionable charges or fraud to Medicare: 800-MEDICARE (800-633-4227) (TTY: 877-486-2049); Medicare.gov.

•  Report suspected health insurance fraud to your insurance company's antifraud department. You should find a number to report fraud on your EOB.

•  You may also want to contact your state insurance department. You can find contact information at NAIC.org.

• Learn more about health care fraud at AARP.org/fightfraud.

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