Medicare Fraud? Tips on How You Can Tell

Medicare and Medicaid services were created to help the elderly and or those with disabilities or certain other medical conditions be able to better afford medical coverage in order to pay for supplies, medical care, treatments, doctor’s visits and much more. This all seems like a good idea if it works the way it should and benefits those it is suppose to. Unfortunately though, there have been more and more cases of Medicare and Medicaid fraud and people are getting sneaky about how they get around the rules. Billing Medicare for services that were not received or provided can cost taxpayers millions of dollars each year and it also hurts those people that really need the medical care and services by causing them to pay more. To help avoid being a victim of Medicare Fraud use the following helpful detection tips. These tips include:

  • Be suspicious if a test is free and if a provider only needs your Medicare information for their records.
  •  Be aware if Medicare wants you to have a certain item or service.
  • Be cautious if the provider knows how to get Medicare to pay for an item or service
  • Be on the look out for provider that offer many tests at cheaper or discounted prices
  • Be careful if the equipment or service is free or you are offered a gift for the service

 

It is also important to know what services and equipment or medical supplies you are entitled to and report or question anything that seems out of the ordinary. As a general rule do not give out your Medicare health insurance claim number expect to your doctor or Medicare provider.

It is unfortunate that many people will try to scam those in need out of services and medical supplies for their own personal gain. It is good to know though that you can do something to help stop cases of fraud.

For additional information on Medicare fraud and prevention, you may visit:

http://www.medicare.gov/Fraudabuse/Tips.asp

If you or a loved one feel you have been a victim of Medicare fraud, please contact a  whistleblower attorney right away. They can help your case to be heard and make sure you get the care you deserve.

How to Report Elder Abuse or Elder Neglect in NJ

Filing a report with the State of New Jersey in the event of nursing home neglect is the first step in pursuing a claim for elder abuse.  The process is very simple and extremely helpful if you have considered taking legal action against the facility.

How It Works

When you call the New Jersey Department of Health and Senior Services,  a representative will discuss and document any problems or issues you are having with the particular nursing home facility.  Based on your information, an investigator will be sent to the facility within ten (10) days to investigate the claim.  The investigator will then review the patient’s chart, interview other patients in the facility and observe the general living conditions.  Based on their findings, the investigator will issue a letter stating the nursing home was either deficient or not deficient in their care according to state/federal laws.

How Does Filing a Report Help My Legal Case?

A report from the state detailing the neglect or abuse experienced by your loved one is a credible piece of evidence in proving your case.  The report may also uncover abuse or neglect that the family was not aware of at the time they made the claim.

Contact the NJ Department of Health And Senior Services:

To file a report, call 1(800) 792-9770.

Follow the prompts and press one (1) to file a complaint against a nursing home, hospital or assisted living facility.

 

Related Information:

New Jersey Nursing Home Abuse Lawyers

New Jersey Bedsores Lawyers

How to File a Hospital or Nursing Home Discharge Appeal With Medicare

If you believe that a Medicare patient is being inappropriately discharged from a hospital or nursing home facility, you must file the following procedure from the Department of Health and Human Services to appeal the decision:

Steps to Appeal Your Discharge:

Step 1:  You must contact the Quality Improvement Organization (QIO) no later than your planned discharge date and before you leave the hospital.  If you do this, you will not have to pay for the services you receive during the appeal (except for charges like co-pays and deductibles).

  • Here is the contact information for the QIO: (800) 624-4557 or tty 1-(877) 486-2048
  • You can file a request for an appeal any day of the week.  Once you speak to someone or leave a message, your appeal has begun.
  • Ask the hospital if you need help contacting the QIO.

Step 2: You will receive a detailed notice from the hospital or your Medicare Advantage or other Medicare managed care plan (if you belong to one) that explains the reasons they think  you are ready to be discharged.

Step 3: The QIO will ask for your opinion.  You or your representative need to be available to speak with the QIO if requested.  You or your representative may give the QIO a written statement, but you are not required to do so.

Step 4: The QIO will review your medical records and other important information about your case.

Step 5: The QIO will notify you of its decision within 1 day after it receives all necessary information.

  • if the QIO finds that you are not ready to be discharged, Medicare will continue to cover your hospital services
  • If the QIO finds that you are ready to be discharged, Medicare will continue to cover your services until noon of the day after the QIO notifies you of it’s decision.

IF YOU MISS THE DEADLINE TO APPEAL, YOU HAVE OTHER APPEAL RIGHTS:

  • You can still ask the QIO or your plan (if you belong to one) for a review of your case:
    o If you have Original Medicare: Call the QIO listed above
    o If you belong to a Medicare Advantage Plan or other Medicare managed care plan: Call your plan.
  • If you plan to stay in the hospital, the hospital may charge you for any services you receive after your planned discharge date.

For additional information, call 1-800-Medicare (663-4227) or TTY: 1-877-486-2048

Related Information:

Contact a nursing home abuse attorney