Was It Fraud?

          I guess it pays to be honest, even if it takes time you don't have and is hard on your nerves.

          Recently I received an Explanation of Benefits from my secondary health insurance carrier.  It was ten pages long and contained the information of all the medical expenses we had in the past two months.  As usual I read through it carefully to check on its accuracy.

          This time I found four entries for Medical Home Care during January, February, March and April.  These amounted to $5,356.28 paid to Medicare and $1,366.40 to my secondary insurance.  Fortunately, the patient responsibility was zero.  However, we had no records of any such expenditures, then or ever.

          So, despite not owing anything I wanted an explanation on what these bills were actually for.  I decided to call my secondary insurance which sent me the report.  Their reaction was that they had no information but that they paid the bill because Medicare had approved it.  If I wanted answers I would need to contact Medicare directly.  Did I really want to do that?  No …. but.

           Now I became involved in the vast Medicare system talking to various clerks and spending large amounts of time on hold.  Finally, I was told that I had to go to the fraud division.  I agreed and they switched me to that office.  And then, after about 90 minutes of searching for an answer, I was cut off.  Completely gone with no call backs.  Frustration!
           I wasn't about to let them win so the next morning I began the process again.  This time I was successful until they finally said I would need to be switched to their fraud department.  I told them of my previous experience with this switch attempt.  This clerk was very understanding and this time the switch was successful.

          But the frustration was not yet over.  Again, I had to go through all the details.  They agreed it could be fraud and they would investigate.  But I would not be told the results.  What a reward for an attempt to save our government money.

          Will they actually do anything?  Will they find the problem and get the money back?  Apparently, we will never know.  It will be another government secret.

          A few weeks later an article "The $80 Million Health Care Fraud" appeared in the AARP monthly magazine.  I found it interesting since I think it backs up my appraisal of this situation. The U.S.Attorney General Merrick Garland advises looking at your explanation of benefits every time you get a statement to check for any inaccuracies.  It might be a mistake or it could be fraud.  That's what I did and what I will continue to do.

          Unfortunately, there are crooks everywhere that money is involved.