It’s open enrollment season for Affordable Care Act health insurance! Here are 11 things you need to know.
by Catharine Skipp, AARP Bulletin, September 1, 2010
Arthur Peterson, 73, spent decades paying attention to detail as a Federal Aviation Administration electronics technician in Miami. Now he examines his Medicare summaries with those same critical eyes.
In 2007, he received a Medicare benefits summary listing services he never received.
"I was looking at a bill and wondering who is charging me for durable medical supplies?" he said. Over three years, Peterson, who is fit and in good health, received dozens of bogus bills for respiratory therapy, diabetic supplies and electronic stimulation.
Peterson spent countless hours trying unsuccessfully to persuade Medicare officials to investigate the fraud. At one point, he said, "they told me to call my doctor and tell him to stop billing them for services he isn't doing." He visited his congressman's office three times. He called his senator and wrote the secretary of Health and Human Services. He even drove by the addresses of companies that had fraudulently billed Medicare, only to find them abandoned.
Three years later, the federal Administration on Aging welcomes the input of beneficiaries like Peterson, whom they are enlisting as the first line of defense against Medicare fraud. The administration's Senior Medicare Patrol (SMP) wants all beneficiaries to be as vigilant as Peterson when reading their Medicare Summary Notices. The patrol is teaming with AARP and groups in every state to train volunteers and spread the word about stopping Medicare fraud.
On a recent morning, more than 50 people met at Temple Emeth in Delray Beach for coffee, juice and pastries—and for Bob Cullen. Cullen, 67, of Boynton Beach, is one of more than 5,000 volunteers nationwide trained by the SMP to coach beneficiaries. His message: Protect your Medicare number, read your Medicare Summary Notices carefully and report irregularities to the toll-free hotline, 1-866-357-6677. Similar events reached about 100,000 Florida beneficiaries in the past two years.
"Our best tool in fighting fraud is preventing it in the beginning by empowering seniors to know what to do," said Barbara Dieker, director of the federal Office of Elder Rights.
South Florida is ground zero for fraudulent Medicare claims. "The fraud perpetrators follow the 'Willie Sutton' principle and go where the money is—there are a large number of beneficiaries who live in the Miami-Dade area, many of whom may be targets of fraudulent schemes," said Peter Budetti, deputy administrator for program integrity at the Centers for Medicare & Medicaid Services.
In hopes of spotting fraud more quickly, South Florida beneficiaries receive their statements monthly, rather than quarterly like the rest of the country. In the first half of this year, Florida had 20,000 compromised beneficiary numbers—numbers that could be used for fraud—compared with the next highest state, Texas, with 5,000, according to the National Health Care Anti-Fraud Association.
Miami was home to the nation's first Medicare fraud strike force in 2007. Since then, more than 810 individuals and organizations have been indicted there for fraudulently billing Medicare for more than $1.85 billion. In the first five months of this year, 140 defendants were charged with $341 million in bogus claims. In one case, former minor league baseball pitcher Ihosvany Marquez pleaded guilty to fraudulently billing Medicare for $61 million. With his share of taxpayer money he purchased racehorses, diamonds, watches and 19 luxury and exotic cars.
In July, U.S. Health and Human Services Secretary Kathleen Sebelius and U.S. Attorney General Eric Holder convened the first in a series of regional health care fraud prevention summits in Miami, featuring a training session on how to detect suspected Medicare fraud. Among the tips: Report suspected fraud online or call 1-800-HHS-TIPS (1-800-447-8477).
Ivonne Fernandez, AARP Florida associate state director for multicultural outreach, said Hispanics are particularly susceptible to fraud. Unfamiliarity with the system and language barriers may play a role.
Medicare fraud has become a hot topic at AARP Florida's Cafe con Leche, a series of monthly community conversations over Cuban coffee and pastelitos led by AARP staff and volunteers—called baristas, the name given to workers in high-end coffee cafes. Although the conversations began as nonpartisan discussions of the facts regarding health care reform, the issue that most often came up was Medicare fraud. "It showed how big the issue was—especially in Miami-Dade County—and how many victims," Fernandez said. The program has 12 to 15 meetings a month with attendance ranging from 20 to 100 per meeting.
"It isn't just Medicare fraud," Fernandez warned. "They are also committing other identity fraud—even getting into [victims'] bank accounts."
Catharine Skipp is a freelance writer and contract reporter for the Miami Bureau of the New York Times.
Please leave your comment below.
You must be logged in to leave a comment.
Get tips and resources to protect yourself from fraud and see the latest scam alerts in your state.
Members save 15% on in-store purchases of frozen yogurt, treats and apparel.
Exclusive program for members from The Hartford.
AARP members receive exclusive member benefits & affect social change.
You are leaving AARP.org and going to the website of our trusted provider. The provider’s terms, conditions and policies apply. Please return to AARP.org to learn more about other benefits.
Your email address is now confirmed.
Manage your email preferences and tell us which topics interest you so that we can prioritize the information you receive.
Explore all that AARP has to offer.
In the next 24 hours, you will receive an email to confirm your subscription to receive emails
related to AARP volunteering. Once you confirm that subscription, you will regularly
receive communications related to AARP volunteering. In the meantime, please feel free
to search for ways to make a difference in your community at