Education key to Medicare fraud prevention

ON PATROL: Charles Fogarty, left, director of the R.I. Division of Elderly Affairs, speaks with Senior Medicare Patrol Manager Aleatha Dickerson, center, and Senior Medicare Patrol Volunteer Coordinator Gail Amitrano. / PBN PHOTO/ MICHAEL SALERNO
ON PATROL: Charles Fogarty, left, director of the R.I. Division of Elderly Affairs, speaks with Senior Medicare Patrol Manager Aleatha Dickerson, center, and Senior Medicare Patrol Volunteer Coordinator Gail Amitrano. / PBN PHOTO/ MICHAEL SALERNO

What can a senior citizen who had her toenails trimmed by a podiatrist do when she receives a Medicare billing statement with a charge for foot surgery?

Seek help from Leo Dery and other volunteers with Rhode Island’s Senior Medicare Patrol project.

From Johnston to Jamestown, Newport to North Providence and points in between, volunteers with SMP, headquartered at R.I. Department of Human Services, Division of Elderly Affairs, teach seniors to scrutinize and analyze their Medicare statements for errors and fraud.

Funded by a grant from the U.S. Department of Health and Human Services’ Administration for Community Living, the SMP has a clear focus: “Protect, detect and report suspected errors, fraud and abuse,” said Aleatha Dickerson, SMP program manager.

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The project serves seniors statewide, so Dickerson works with six partner agencies that coordinate with several smaller organizations to spread the word to seniors about how best to “protect, detect and report.”

“There are no dumb questions [about Medicare],” said Dery. Most mistakes he sees are clerical errors that a call to the doctor’s office can resolve, but fraud, such as the case of the podiatrist above, occurs, said Dery. Volunteers generally serve their own community; Dery, of South Kingstown, volunteers at the South Kingstown Community Center.

The project, which began in 2006 in Rhode Island, educates Medicare enrollees and their caregivers about protecting their Medicare number to avoid identity and medical identity theft, reviewing their Medicare summary and explanation of benefits and flagging potential mistakes. Straightforward problems are resolved at the state level, but Dickerson will send particularly complex issues to the federal government for review and action.

While recovery of fraudulent payments is part of the mission, Elderly Affairs Director Charles Fogarty emphasizes the benefit of empowering people with knowledge so they can help prevent fraud and abuse.

“The system works, [but] it’s a lot more expensive and a lot more complicated to try to get the money back than to have people say, ‘Wait a minute, [I have a question about this charge],’ ” he said.

Citing information from federal agencies involved in pursuing Medicare claims, Dickerson said that $8 are recovered for every dollar spent on an investigation. In 2014, the United States recovered slightly more than $2 billion in charges improperly paid, through Medicare errors, fraud or abuse. Information about Rhode Island recoveries was not available, she said, though they do occur.

She cited the local example of John Almon of Cranston. In 2011 Almon, then owner of Med Care Ambulance LLC, received a two-year federal prison sentence after pleading guilty to obstructing a federal audit, making false statements and committing two counts of health care fraud, according to the HHS Office of Inspector General’s semi-annual report to Congress, spring 2012. Charged with overbilling Medicare and Blue Cross & Blue Shield of Rhode Island – by categorizing ambulance trips for dialysis patients as specialty care transports, which are reimbursed at a higher rate – Almon was ordered to pay more than $700,000 in restitution and complete 1,000 hours of community service.

The theft of someone’s Medicare number doesn’t benefit the thief as much as it negatively impacts the person whose identity is stolen, said Gail Amitrano, SMP volunteer coordinator. If someone steals a Medicare enrollee’s Medicare number and fraudulently purchases a wheelchair, for example, that enrollee will not be able to get a wheelchair through Medicare.

The Rhode Island project received $229,000 in federal funds for June 2015 through May 2016 – the first year of a three-year grant; no state funds are allocated for SMP.

“Rhode Island’s dollars may not look like a lot, but if you look at states like California and Florida that are getting less than half a million dollars, we’re actually making out fairly well under the system,” Fogarty said.

Adults of any age, especially those with knowledge of a second language, including American Sign Language, are encouraged to volunteer, said Amitrano. The time commitment for and frequency of assignments, ranging from administrative office work to distributing information, public speaking and counseling seniors, vary. Some volunteers participate because of experience with Medicare fraud; others want to help while educating themselves.

Learning something new and contributing to her community inspired Barbara Hackett to begin volunteering about five years ago. The Warwick resident, who educates groups about Medicare through West Bay Community Action, said, “It’s caused me to be up-to-date on what’s going on in Medicare; it’s a huge benefit to me and my friends.” •

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