Medicare fraud

Yes, there is plenty of fraud in Medicare and CMS does a poor job of uncovering it and yes a lot of it exists with the knowledge of seniors. However, the quote below about prescription drugs is not fraud and the statements are misleading. Every prescription drug has side effects – just listen to the ads on television. Doctors don’t have much choice. But a critical part of all this is the patient.

It is the patient’s responsibility to be sure the doctor is aware of all drugs (including OTC) being taken, to ask for a generic or lowest cost drug suitable and I would also ask for the oldest most suitable drug that has been tested by time.

If a drug is not covered by your plan, tell your doctor or there being no option, make sure you use GoodRx or similar program to lower costs. I had a drug prescription go from $695 to $196 doing that.

While some attempts at fraud tend to be more obvious, such as suspicious telephone calls offering “free” services covered by Medicare, abusive or wasteful billing by providers can be more deceptive and hard to spot. Here are a few examples of how Medicare waste and abusive billing can occur:

• Prescription drugs: Doctors often prescribe drugs that can cause serious side effects which may then require follow-up treatment or even another prescription.  Healthcare providers need to review medication lists regularly to weed out prescriptions that are ineffective or no longer required.  Doctors may prescribe pricey drugs that aren’t covered by the patient’s drug plan, but there might be equally effective, less costly drugs that can be tried.
• When the medical practice has been bought out by another firm. Calling it the “golden age of colonoscopies” Kaiser Health News reports that private equity firms are buying up colonoscopy and other types of specialty medical practices.  With profit as those firms’ primary objective, patients are finding they may pay much more for the same or even receive less care. Medicare covers the full cost of preventive colonoscopies without patient cost sharing, but when there is an existing condition, patients can be on the hook — often for considerably higher costs when the practice is controlled by private equity-backed investors. A shortage of experienced nurses, administrative staff, and even doctors can be a red flag. Asking a doctor for a referral to a different provider may not even be an option in some areas, where private equity companies have bought up all the practices to ensure they are the only game in town.

Senior Citizens League