Question: For the second time, a local doctor’s office is using deceptive billing practices with my mom, who has Medicare Advantage health insurance. It’s infuriating. Where can I report this deeply unethical and possibly illegal behavior?
Answer: Senior Medicare Patrol Hawaii urges any patient who suspects Medicare fraud to address it immediately, first by ruling out billing errors and then by reporting the matter for further investigation as warranted. The volunteer-based federal program suggests that patients with questions about apparent discrepancies on a Medicare Summary Notice or Explanation of Benefits start by calling their doctor or Medicare Advantage Plan to rule out billing errors. However, if the patient doesn’t feel comfortable making that call, or if they call but are not satisfied by the provider’s or plan’s explanation, SMP can assist.
SMP helps patients “identify and report fraud schemes and deceptive health care practices, such as illegal marketing or billing for services that were never provided,” according to its website. And it helps refers fraud complaints to the appropriate investigative entity, such as the U.S. Department of Health and Human Services’ Office of Inspector General, the Centers for Medicare & Medicaid Services, the Department of the Attorney General, local law enforcement, the state Department of Commerce and Consumer Affairs or the state Department of Human Services’ Med-Quest Division.
To reach SMP, call 808-586-7281 on Oahu or, from elsewhere in the state, call 800-296-9422 toll-free. Or submit a request through SMP’s website. Go to https://www.smphawaii.org/about-us/ and fill out the online form for a “Counseling Request.”
Whether you call the provider, plan or SMP, make sure you have the questionable bills in hand, and be prepared to take careful notes and document your actions.
You also might choose to report suspected fraud directly to Medicare, although readers we’ve heard from in the past preferred reviewing their concerns first with a local contact, such as SMP. For instructions on reporting suspected fraud and abuse to Medicare, go to 808ne.ws/3VUJRj1.
Examples of provider fraud including billing for a treatment, test, prescription or equipment that the patient didn’t actually receive; various methods of overcharging, including by billing for a more expensive treatment or equipment than the patient received; multiple billings for a single treatment; inflating treatment times for services billed by the hour; and numerous other possibilities. Medicare fraud and abuse can result in higher health care costs and taxes for everyone, the Medicare website says.
Q: Please let people know to get free leak detectors. I got them in 2023 and they work.
A: You are referring to dye tablets that are dropped in a toilet tank to determine whether the toilet flapper valve is leaking. If, without flushing, the water in the toilet bowl takes on the dyed color in the tank, there’s a costly leak that isn’t difficult to repair. Customers who fix it by replacing the toilet flapper valve can save money on their water bills. The dye tablets will be given away during Detect-A-Leak Week, which is April 14-20 in Honolulu. They’ll be available for free at the Honolulu Board of Water Supply’s Public Service Building, Hardware Hawaii locations and at Oahu’s satellite city halls, according to a BWS news release. See more water conservation tips at boardof watersupply.com/dalw.
Mahalo
Mahalo to nonprofit organizations and volunteers who are letting our COFA neighbors know that after all these months they are eligible for federal disaster aid for the Maui fires. I know the Federal Emergency Management Agency has made announcements, but word needs to spread far and wide because for so long these folks were told “no.” Mahalo to the groups that are amplifying this good news. — A reader
(Editor’s note: COFA citizens from the Republic of Palau, the Federated States of Micronesia and the Republic of the Marshall Islands who are legal U.S. residents have until May 31 to apply for FEMA disaster assistance if their primary home on Maui was damaged by the August wildfires, according to a FEMA news release. For details, go to 808ne.ws/3PZsp98.)
Write to Kokua Line at Honolulu Star-Advertiser, 500 Ala Moana Blvd., Suite 7-500, Honolulu, HI 96813; call 808-529-4773; or email kokualine@staradvertiser.com.
