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Older adults: Be aware of medical equipment fraud

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Policyholders play a vital role in fighting fraud claims


Recently, the National Association of ACOs (NAACOS), a health-care nonprofit that represents hundreds of medical groups and hospitals across the nation, uncovered a medical equipment scheme that allegedly defrauded an estimated $2 billion from Medicare. Seven companies allegedly falsely billed Medicare for urinary catheters that weren’t needed or received.

Butch Spicka, Senior Compliance Analyst at Wellabe, says senior policyholders, especially Medicare beneficiaries, are being billed at an alarming rate for medical equipment and services they don’t need or haven’t received. It’s called durable medical equipment (DME) fraud.

Spicka says the Wellabe claims department has received claims for items ranging from catheters for people who didn’t need them to glucose monitors for people who aren’t diabetic.

“We want to alert everyone of these fraudulent claims. They could impact premiums,” he says. “We’ve been contacted by some of our policyholders who have let us know about cases where they have not received or did not request the equipment or supplies that have been billed. This has saved approximately $3 million for invalid claims for assorted durable medical equipment.”

Spicka says what’s even more alarming is the amount of falsified medical records coming in from these providers that include forged doctor’s signatures. 

What to do if you suspect fraud

“We encourage you to review all the correspondence and Explanation of Benefits (EOB) statements that you receive, from Medicare and any other coverage you may have, such as a Medicare Supplement or Medicare Advantage plan, and if you see something that’s just not right, you should contact your carrier,” Spicka says. 

If you suspect a fraudulent charge on your Wellabe bill, please:

If you’d like to learn what else Wellabe is doing to fight fraud, visit our anti-fraud webpage.


Photo credit: iStock

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