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Volunteers Wage Fight against Health Care Fraud

Health care fraud is big business across the U.S., ranging from $80 billion to $160 billion in losses each year. The Federal Trade Commission estimates that consumers themselves lose more than $10 billion annually to health care fraud.

As part of a nationwide effort to fight health care fraud and combat waste, Nebraska’s Senior Medicare Patrol (SMP) relies on a dedicated corps of volunteer educators. Volunteers help people in their communities identify and report possible Medicare or Medicaid fraud, error or waste and give consumers tips on how they can protect themselves from being victimized.

Last year, about $1.2 million in suspected health care fraud in the state was referred to investigators, according to SMP Project Director Madhavi Bhadbhade with Nebraska’s Department of Health and Human Services.

“This criminal activity hurts beneficiaries because Medicare and Medicaid money is wasted that could be used to increase and improve health care services,” she said. “It affects everyone by throwing away billions of taxpayer dollars. Our volunteers empower consumers to recognize the signs and report potential cases of fraud for further investigation and action by the proper authorities.”

Bhadbhade said the most common complaints from consumers involve billing errors and improper claims, such as Medicare being billed more than once for the same procedure, for services never ordered by a doctor or for something a patient never received. In 2009, a court ordered a now-closed Lincoln scooter store to pay back a combined $250,000 to Medicare and Medicaid after a beneficiary tipped off the state to high pressure sales tactics.

More than 100 SMP volunteers and staff educated nearly 25,000 older Nebraskans about how to avoid becoming victims of health care fraud in the past year. They visit senior centers, nursing homes, retirement communities, health fairs and elsewhere to encourage Medicare beneficiaries to guard their personal information, be alert to suspicious sales pitches and carefully review their Medicare paperwork for accuracy.

“Volunteers connect us with the public and are critical to our success. We’re always seeking interested volunteers throughout Nebraska who want to make a real impact by joining our efforts to crack down on health care fraud,” Bhadbhade added.

To learn more about volunteering or to file a complaint of possible Medicare or Medicaid fraud, contact Nebraska SMP toll free at 1-800-942-7830. Read about fraud prevention tips and consumer alerts at www.dhhs.ne.gov/smp.

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