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Home health services are a prime target for Medicare fraud

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Scammers bilk tens of billions of dollars from Medicare every year — usually through unsuspecting beneficiaries who are convinced by these ne'er-do-wells that Medicare will pay for equipment or tests. Bogus home health services are a multibillion-dollar offender. In most of these scams, the beneficiary is not entitled to services, but is convinced to believe they should accept them, and that Medicare will pay.

 

How It Works

  • A beneficiary receives a call or home visit asking if he could use some free help around the house that Medicare will supposedly pay for.
  • A fraudulent physician may falsely certify that the beneficiary is unable to administer certain self-care. For example, the doctor may falsely claim a beneficiary is diabetic and cannot inject herself.
  • A crooked physician may fraudulently certify that a beneficiary is homebound.
  • Many home health schemes involve no actual home health therapy. Instead, the Medicare beneficiary is asked to sign forms that verify a nurse or therapist showed up at her home and provided services when they did not.

What You Should Know

 

  • Medicare does not pay for home health care services unless a beneficiary is under a doctor's care, and that the doctor certifies a need for physical, occupational or speech therapy, or intermittent skilled nursing care.
  • Further, the beneficiary must be homebound, meaning he or she can't or shouldn't leave home or needs special transportation or great effort to do so.
  • Home health services that do not meet these requirements are fraudulent.

What You Should Do

 

  • Do not accept money or "free" services in exchange for your Medicare number.
  • Review your Medicare Summary Notice or your Explanation of Benefits (private insurance) for suspicious charges.
  • Report questionable charges or sales pitches to Medicare at tel:800-633-4227.
  • If you have been targeted by this scam or have fallen victim, call the AARP Fraud Watch Network Helpline at tel:877-908-3360 for guidance and support.
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