ATTN: Medicare Beneficiaries - A Question

[GailL1]

  Do you routinely monitor and verify your Medicare usage on your Medicare Summary Notices ?  If for no other reason than to verify the charge is yours?

[Winter2025VA]

[2/28/25] Yes I do @GailL1 .

[TRL1111]

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@GailL1 wrote:

  Do you routinely monitor and verify your Medicare usage on your Medicare Summary Notices ?  If for no other reason than to verify the charge is yours?

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Always.  If nothing else, it reminds me why it's worth it to pay extra to have a Plan G because I hate deciphering EOBs.  I hate it now, when I'm healthy and usually don't even meet my Part B deductible, and I'm sure I'm going to hate it even more when I get older and crankier AND have more EOBs to deal with.

Plus, yeah, I'm definitely the type to report errors even if they don't cost ME money.

[shamit]

Yes.  I do.  I found a claim that wasn't mine 2 or 3 years ago.  I called Medicare and reported it.  They said they would look into it.  After that it was reported that many Medicare numbers were stolen from the Medicare system and Medicare had paid out a lot o money in false claims mostly for catheter products.  That was exactly what the phony claim was on my account.  I never used any catheters.  It was prescribed by a doctor half way across the country from me who I didn't even know.

Medicare said when they finished investigating a new MSN would be posted with the corrected information. I am still waiting for that to happen.  Apparently that company gets to keep that money.  So much for stopping fraud.

[GailL1]

@shamit 

Thank you - you did what you should have done.  However, it is an ongoing problem - they let the catheter thing go and now they do other things - more expensive things like CGMs and the monitoring.  DME is a very big place for these scams.  A person I know got a MSN from her DECEASED husband account on a CGM and monitoring to the tune of $ 2700 - Medicare paid it, she reported it but to this day has gotten nothing that showed what happened or if they got the money back.  Now how did this get through?  Her husband had been dead for months - then out of the blue this current charge pops up with his Medicare number - yes he did have a CGM and monitoring - then the wife decided to check her blood sugar in passing because she had some left over - who know if this had anything to with the scammers???

The other thing I wanted to know was if you got a corrected MSN .  Yes, you are like others - report it and never hear another thing.

Are we getting the money back?  That seems to be the $ 24,000 question; maybe the 24 million question.

 WE now require all DME to be approved by Medicare but then the scammers just use their vendor number and a beneficiary number and they get the money - BUT WAIT - my question is the address that they send the money to - was it recently changed or is it really the address of the DME provider. 

I am glad you reported it and I want to hear from others too.  

Thank again/

[shamit]

@GailL1   It really bothered me because there were 2 catheter claims on the same MSN exactly 1 month about.  Each of them was for over $3000+.  That is over $6000 in fraud.  They paid it and the MSN was never corrected.  From what they told me I would assume that meant if they never got the money back.  That is not how you stop fraud.  I hope you hear from sone others with false claims.  This is the big problem.  I don't know how they will stop it if they cut staff even more.

[GailL1]

@shamit 

Of course, they can stop it - if they stop to verify.  Contractors process Medicare claims - but of course, Medicare is not managed care so the processors rarely questions any claim for consistency with diagnosis and best practices.  Yes, until the problem is huge, they rely on a beneficiary reporting it and filing a complaint.

Yes, I agree that if they find the claim is fraudulent, you should have a credit issued or a reversal of the processing and the amount should be put in another account where the complete investigation takes place to recover the funds or to put the culprits in jail.

In the case I described - when a beneficiary dies, their account should be flagged in some way for extra scrutiny.

I understand they are rushed to get stuff done, but a job that is only done half-assed really isn’t really done.

Just guessing but I don’t think you would see such incompetence in Medicare Advantage plans - thus we should not have to accept it in the traditional program either.