Question: I just received a statement from my secondary health insurance reimbursing $4,000 for catheters I supposedly received every month from May 2023 to February 2024 from a company. It listed the months and a total of $20,000 in charges billed to Medicare. I called my secondary insurance to open a fraud case. I have never signed up for nor received any of the catheters. They suggested that I also call Medicare and open a fraud case, which I did. If my secondary insurance had not sent the reimbursement check and statement, I would not have known about these charges and then in the future Medicare would have sent me their billing statement with my portion of this large amount. Please warn your readers that there is about $2 billion in fraud just like my case, billing Medicare for catheters. They should check their Medicare accounts online to see if there are charges that don’t seem right.
Answer: This catheter scam is so pervasive that the U.S. Department of Health and Human Services Office of Inspector General issued a consumer alert about it last month (808ne.ws/ 4d7n5ue), after it was reported that a huge spike in catheter claims indicated massive fraud, potentially of more than $2 billion. Federal investigations are underway. Some Medicare members whose accounts are used to fraudulently bill Medicare for urinary catheters or other at-home medical equipment they don’t need and never receive don’t notice the fraud, because they aren’t charged a co-payment, don’t have secondary insurance that sends a statement or reimbursement and don’t carefully review their Medicare account.
You did the right thing by reporting the fraud to your secondary insurer (and returning the check) and to Medicare. Medicare members should regularly review their statements for suspicious billing, which they can do online at medicare.gov, as you suggested, by either logging on to their existing account or creating one.
After reviewing their statements, anyone who suspects Medicare fraud or abuse should report it to either:
>> Medicare: 800-633-4227, medicare.gov
>> HHS-OIG: 800-447-8477, TIPS.HHS.GOV
>> Senior Medicare Patrol Hawaii: 800-296-9422, smphawaii.org
Medicare billing scams end up costing everyone, even when patients don’t directly pay a portion of a fraudulent bill. If Medicare loses massive amounts of money to fraud, that may increase premiums for future enrollees, and reduce trust in the federal health insurance program for people 65 and older.
According to national reports, most of the fraudulent catheter claims are submitted by a few purported durable medical equipment (DME) companies.
As for how criminals are getting so many people’s account information, the HHS-OIG alert said scammers “are targeting Medicare enrollees through phone calls, internet ads, and text messages with offers of free services, medical equipment, or gift cards upon confirming their personal information and eligibility for specific Medicare services. Often, the enticement for the individual is that they are ‘qualified’ for items ‘at no cost’ or ‘free.’ Once the scammers obtain the enrollee’s personal information, monthly billing to Medicare will begin for medically unnecessary urinary catheters that may or may not actually be sent to the enrollee.”
While it’s certainly important to remind individuals to “be suspicious of anyone who offers you free medical equipment and then requests your Medicare number,” and to hang up on anyone calling with promises of free urinary catheters billed to Medicare, the HHS-OIG alert doesn’t mention another source of ill-gotten account information: data breaches.
Health care companies are among cyberthieves favorite targets, with numerous examples over the years of private information illegally accessed. For example, just last week hackers reportedly began selling patient information stolen in February’s breach of Change Healthcare, which handles millions of U.S. medical records. And a cyberattack last year on Navvis & Co. exposed the health records of 765,370 Hawaii Medical Service Association members, according to updated figures reported to the state Office of Consumer Protection. Medicare ID numbers were among the patient data exposed, Navvis said in letters to affected HMSA members.
Bottom line: All Medicare enrollees should be alert for potential fraud, and report it accordingly.
Mahalo
As a regular Blood Bank of Hawaii donor, I just want to thank Anna at the Blood Bank’s Young Street location and the many other staff who are true professionals. Mahalo for all you do to make blood, platelets, and plasma available for Hawaii’s health care community. — L.H. Oshiro
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.
