For Professionals: Medicare fraud and abuse

SMP Volunteer Highlight of Recent CMS Press Conference

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Published: February 6, 2008

Joe O’Malley and his service as a Senior Medicare Patrol (SMP) volunteer were the spotlight of a recent Center for Medicare and Medicaid Services (CMS) press conference on a new policy concerning potential durable medical equipment (DME) suppliers. After an address from CMS Acting Director Kerry Weems announcing this new policy, Joe spoke about a recent incident where he was solicited for diabetic supplies while sitting in the dialysis center receiving dialysis. While he declined the supplies, he still received them a week later. Being a highly knowledgeable SMP volunteer and the target of a common DME scam, Joe provided the press with a rich interview opportunity – whose enthusiastic interest and questions made Joe the highlight of the conference.

From his work in fraud prevention since 2001, Joe knew that being solicited for supplies while receiving treatment was against the law. He also knew that Medicare didn’t just provide ‘free’ diabetic monitors to anyone who wanted one. When he received diabetic supplies and a monitor in the mail a week after the incident, and then his Medicare Summary Notice (MSN) stating Medicare’s payment of this unwanted equipment a couple weeks later, he knew he was dealing with a case of Medicare fraud. In his weekly volunteer work at California Health Advocate’s SMP office, Joe enters all the fraud reports that come in from around the state and directs them to the correct fraud investigation agency. This time he got to file his own case.

Given the press coverage of this incident, CMS has already contacted this supplier and had them withdraw their charges to Medicare; a fraud investigation agency is also investigating this case. Congratulations Joe on a job well done!

If you or your clients have any similar incidents, or are suspicious of other potential fraud cases, contact your local SMP counselor at the Health Insurance Counseling & Advocacy Program (HICAP) near you at 1-800-434-0222. Also, view our Medicare fraud fact sheet PDF for a list of common fraud schemes and effective prevention tips:

For more information on the new policy concerning potential DME suppliers and its effect on beneficiaries, see CMS’ press release and website section on competitive bidding.

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