| |
| Protect
your identity |
| Provider Numbers are being: |
| · |
sold
on the black market for $50 – A
warehouse full of them was seized in Florida |
| · |
obtained off internet |
| · |
gotten
from obituaries – criminals look for
deceased providers and then ask for duplicate records |
| |
|
| Once someone has
stolen your identity they may then: |
| · |
Purchase Medicare numbers illegally (this has happened
at a Waterloo senior housing unit) |
| · |
Submit billings under your name for patients they have purchased
and make it look as though you are guilty of fraud. |
| · |
Complete a change of address form to divert your
mail to another location. They simply add a suite number to
your address and payments are actually sent to a privately
owned mailbox. The perpetrator then collects the check and
deposits them into a commercial bank |
| |
|
| Protect your records |
| Criminals are purchasing
garbage to obtain billing information that has been discarded.
Specifically they are looking for: |
| · |
Patient’s personal information along with
their Medicare and insurance number’s |
| · |
Provider
number’s of physicians, therapists, lab technicians |
| · |
billing codes |
| · |
billing forms |
| |
|
| The information found in garbage
may allow a wrongdoer to bill Medicare for medical services
that never took place.
These types of practices erode the medical profession; to
avoid falling victim to this type of wrongdoing always seal
your records and shred documents.
|
| |
|
| Protect your work areas |
| Be mindful of who has access
to your computers: |
| · |
Use password protection |
| · |
Require employees to log off at the end of their shift; and |
| · |
do not allow them to place their passwords where anyone else
might see them |
| |
|
| Be conscious of the way
traffic flows |
| · |
Could someone standing in line hear or see confidential information? |
| · |
Do your monitors face the public? |
| |
|
How many people handle your records?
How well do you know them?
Conduct background checks on the people that you employ |
| · |
Janitorial staff: they have access to areas when others are
not around |
| · |
Receptionists: criminals may also offer money to them for
Medicare numbers |
| · |
Billing clerks: hiring the wrong person for your billing
department could cause problems. According to Maryland Attorney
General, Rose Ettlin, a former billing clerk for Dr. Sukh dev
Aujla, was convicted of forging Medicare checks. She stole
32 Medicare payment checks and 19 insurance reimbursement checks
during her 13 months of employment. She then altered the checks
in order to endorse and cash them for herself. Her haul equaled
$11,904.73. |
| |
|
| Don’t
forget the services you contract for |
| · |
Refuse companies |
| · |
Janitorial
firms. An Iowa physician had information taken from his office
by a person working for the janitorial service.
The custodian photocopied the provider’s information,
superimposed his name and signature, replaced the license,
charged Medicare with his provider number, all without the
physician having the faintest idea that his identity had been
stolen. |
| · |
Billing
firms. The third party biller who prepares and remits claims
to Medicare or Medicaid for health care providers. It
is possible for them to defraud Medicare/Medicaid and other
insurance carriers by adding claims without the provider’s
knowledge and keeping the remittances. |
| · |
Suppliers. One scheme being used by unethical and phony
suppliers to obtain Medicare numbers is to invite seniors to
a party with dinner and entertainment. When they arrive they
are asked to drop their Medicare cards in a container to be
used in a drawing for prizes. While the seniors enjoy the food
and entertainment, employees of the supplier go through the
Medicare cards and writing down the numbers. At the end of
the event the cards are returned to the seniors and few weeks
later, counterfeit claims are submitted under the Medicare
numbers of the seniors who attended the party. |
| |
|
| If
you think imposters wouldn’t
relocate into Iowa, think again. In February 1999 David Schultz
answered an advertisement for a physician at the Mapleton,
Iowa clinic. Schultz stated on his application he was a graduate
of Texas Tech Medical School in Lubbock Texas. He produced
letters of recommendation from doctors that he had worked with.
The clinic hired Schultz with a $35,000 sign on bonus and a
$15,000 advance in salary. Schultz treated 26 patients before
the clinic discovered that he was an imposter. Schultz had
not graduated from Medical School, but had worked as a nurse
aid in Springfield, Missouri before relocating to Iowa. Schultz
was ordered to repay the Mapleton clinic $50,000 and sentenced
to 5 years in prison for practicing without a license. Not
much of a penalty for putting lives at risk and marring your
profession. |
| |
|
| The value of this program for providers
of health care services may be underestimated. It is our goal
to create responsible beneficiaries. Our corps of volunteers
train people to: |
| 1. |
Rely on their physician to recommend medical services
and equipment |
| 2. |
Understand their billings. Most often when someone questions
a bill, they are looking for clarification. We encourage them
to: |
| |
a. |
Call the provider. If a mistake has occurred,
they will correct it and make a refund to Medicare |
| |
b. |
Call the supplemental insurance carrier; a 20% refund is
due to them also |
| |
c. |
If they simply are totally overwhelmed call ORT at 1-800-423-2449
and a trained volunteer will assist them |
| 3. |
Spot deliberate scams, which erode
the system and tarnish your reputations |
|
