Protecting Your Practice From Medicare Fraud
October 4, 2000
HCFA Headquarters,
Washington, DC
WASHINGTON, DC—In an effort to curb the tide of rising healthcare costs stemming from fraudulent Medicare activity, officials at the Health Care Financing Administration (HCFA) announced new anti-fraud guidelines at its annual meeting last week.
"Medicare fraud is a $250 million per year industry," said spokesperson Althea Higginson. "We're hoping that, with these new guidelines, physicians and office staff will be able to spot it quickly, and take immediate steps to report it."
HCFA's Medicare Fraud And You booklet, available for free through their toll-free number, details several of the more common scams:
Common Medicare Scams
(Excerpt from Medicare Fraud And You)
The Ketchup Toss: While making rounds, you suddenly feel something hit you from behind. Someone has thrown ketchup onto your white coat! A Medicare investigator (or two) comes up to you and says it "came from over there." You look, while the Good Samaritan(s) clean you up... AND TAKE YOUR WALLET!
Three Card Monte:You're walking between exam rooms when you come across a group of Medicare investigators watching some kind of card game. You go in closer and see one investigator winning lots of money. As the lucky "winner" walks away counting his take, you elbow in for a chance at the free dough. The rules are simple. You bet, you try to find the red card, you pick, and... YOU LOSE.
You Can Be A Model/Star!: You're on your way to review x-rays when you're approached by a gentleman who "works for the Smith modeling agency." (Actually, a Medicare investigator). He tells you that you have the face he's been looking for, for his next ad campaign. You blush; he tells you you'll need a portfolio, and may even give you the card of a photographer to go to for headshots, and some acting lessons. You pay $500 for photos, and another $500 for lessons. The next day, when you go back, you find the only lesson you've learned is that... YOU'RE NOW OUT $1000.
According to Higginson, spotting such fraudulent Medicare activities "isn't easy at first, but once you start to realize how much you've been gypped all these years, you start noticing these goons everywhere!"
HCFA urges all healthcare practitioners who suspect Medicare fraud to contact their local AMA chapter.
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