Elderly Medicare beneficiaries in senior housing and centers are frequently targeted for Medicare fraud schemes, often enticed by free services such as pedicures in exchange for Medicare ID numbers that fraudsters use to bill for expensive services, according to The Dallas Morning News.
These scams are particularly difficult to identify among the sheer volume of claims that are submitted to CMS daily. Claims are usually paid before there is any indication of foul play, according to the newspaper. In some cases, a podiatrist comes to senior homes with a nail salon crew offering free pedicures and then bills Medicare for more expensive debridement procedures for diabetics.
Last summer, a company arrived at a Dallas senior center offering free genetic testing for Medicare beneficiaries. A consultant informed seniors that the testing would help avoid adverse drug reactions, but the expensive tests are only reimbursed by Medicare if they are medically necessary.The seniors provided their Medicare ID numbers, had their mouths swabbed, and were then given ice cream sandwiches. In 2013, FierceHealthPayer: Antifraud reported that improper genetic testing was of special interest to investigators at the Office of Inspector General (OIG).
Home health, hospice and durable medical equipment claims have been fraud hotspots, particularly in the Dallas area, according to The Morning News. Across the country, home healthcare fraud cases have cost Medicare anywhere from $56 million to more than $100 million. A special strike force in Dallas has pulled in 63 indictments and 43 convictions over the last five years.
Meanwhile, the Texas Health and Humans Services Commission has come under fire over the last year for organizational mismanagement and failure to adhere to internal policies.
- read The Dallas Morning News article
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