WARNING: I just found a fraudulent Medicare claim in my account. Appears others did too

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LookinAround
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WARNING: I just found a fraudulent Medicare claim in my account. Appears others did too

Post by LookinAround »

By default, both my Medicare and BCBS Medicare Supplement accounts display claims sorted by service date, most recent to oldest. I think the fraudsters count on it. They submitted a single claim, with multiple service dates, ranging from January to October, 2023. As a result, the fraudulent claim gets listed among your January claims – which puts it way out of sight. If I didn’t happen to have reason to look at January and they didn’t use a provider name that stood out “Pretty in Pink Boutique” I may have never noticed it. An internet search reveals it's the name of a real medicare provider. Their website claims it’s not them and to report it Medicare.

Whether it’s really them or not, it’s clear many have been affected. Check your claims and report it, if found. (I'd think Medicare should be flagging this provider already. But who knows. Whoever I spoke to at Medicare didn't know anything about it and flagged it for me).

I never gave my Medicare number to anyone other my providers. So, if the fraudsters have mine, they likely have yours too! Be careful out there.

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Retired 2017
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Re: WARNING: I just found a fraudulent Medicare claim in my account. Appears others did too

Post by Retired 2017 »

Same thing happened to me and DW twice. One of DW was Same Pink as you. All 3 were involved as Catheter supplies.
We found out about it as we reviewed the periodic Medicare mailing. The charge did not appear on the supplemental mailing.
Each time we called Medicare as well as Supplemental plan.. We spoke to several different nice Medicare people with each fraud report. (prepare for waiting time) They did say that the name of the biller sounded familiar. . Ours involved a time span of charges of about 6 months all filed together. . We received no followup. I do not review the accounts on-line very frequently.
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LookinAround
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Re: WARNING: I just found a fraudulent Medicare claim in my account. Appears others did too

Post by LookinAround »

Retired 2017 wrote: Tue Jan 02, 2024 2:39 pm Same thing happened to me and DW twice. One of DW was Same Pink as you. All 3 were involved as Catheter supplies.
We found out about it as we reviewed the periodic Medicare mailing. The charge did not appear on the supplemental mailing.
Each time we called Medicare as well as Supplemental plan.. We spoke to several different nice Medicare people with each fraud report. (prepare for waiting time) They did say that the name of the biller sounded familiar. . Ours involved a time span of charges of about 6 months all filed together. . We received no follow-up. I do not review the accounts on-line very frequently.
I don't review my medicare accounts frequently either. I have a friend who does it every quarter. But this case makes me realize that's not sufficient because Medicare sorts claims based on service date not claim date. You may have already reviewed Q1 when scammers file their claim in Q4. Medicare will list the new claim back along side Q1 claims . So if you reviewed Q1 in the past, you wouldn't know a new Q1 claim has slipped in.

Medicare should allow one to review by CLAIM date, not just service date. IMHO It could help catch these things sooner if not even letting them slip through the cracks. But who ya going to suggest that too that'll make a difference? After all, it's the government!
HomeStretch
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Re: WARNING: I just found a fraudulent Medicare claim in my account. Appears others did too

Post by HomeStretch »

I recalled this thread when I read this linked article. The Washington Post’s article, linked below, and other news outlets report the Pretty in Pink catheter fraud is a $2 billion Medicare fraud.
https://www.washingtonpost.com/national ... catheters/
Parkinglotracer
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Re: WARNING: I just found a fraudulent Medicare claim in my account. Appears others

Post by Parkinglotracer »

HomeStretch wrote: Sat Feb 10, 2024 7:27 am I recalled this thread when I read this linked article. The Washington Post’s article, linked below, and other news outlets report the Pretty in Pink catheter fraud is a $2 billion Medicare fraud.
https://www.washingtonpost.com/national ... catheters/
A decent data base search tool should be able to reveal this fraud early on … just like when one pharmacy in Florida had sold enough opiates to juice everyone within a 500 mile radius three times a day … took a bit for the gov to catch on.
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PottedPlant
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I'm confused

Post by PottedPlant »

This is confusing to me.
I read the WaPo article.
I went to the Medicare website and found no payments' records.
I have Kaiser Medicare Advantage and have never dealt with Medicare, only with Kaiser.
Mashed or Baked Potatoes?
talzara
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Re: I'm confused

Post by talzara »

PottedPlant wrote: Sat Feb 10, 2024 1:53 pm This is confusing to me.
I read the WaPo article.
I went to the Medicare website and found no payments' records.
I have Kaiser Medicare Advantage and have never dealt with Medicare, only with Kaiser.
The OP has Original Medicare and Medigap. The Washington Post article is also about Original Medicare.

You have Medicare Advantage. Providers submit bills directly to the insurance company, not Medicare.
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PottedPlant
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Back to sleep for me

Post by PottedPlant »

talzara wrote: Sat Feb 10, 2024 5:02 pm You have Medicare Advantage. Providers submit bills directly to the insurance company, not Medicare.
Thanks.
Another reason I like Kaiser.
Mashed or Baked Potatoes?
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nisiprius
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Re: WARNING: I just found a fraudulent Medicare claim in my account. Appears others did too

Post by nisiprius »

Thanks for the heads-up. I checked, and it didn't affect me.

I assume you would also catch this if you skim the periodically mailed Medicare Summary Notices, without the need to scroll back to catch newly submitted claims with old dates of service... right?
Annual income twenty pounds, annual expenditure nineteen nineteen and six, result happiness; Annual income twenty pounds, annual expenditure twenty pounds ought and six, result misery.
RudyS
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Re: WARNING: I just found a fraudulent Medicare claim in my account. Appears others did too

Post by RudyS »

nisiprius wrote: Sat Feb 10, 2024 8:44 pm Thanks for the heads-up. I checked, and it didn't affect me.

I assume you would also catch this if you skim the periodically mailed Medicare Summary Notices, without the need to scroll back to catch newly submitted claims with old dates of service... right?
I would think the same thing. I review each summary notice as they come in. BTW mine are online, I get an email when a new one is available. No more paper for me.
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whodidntante
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Re: WARNING: I just found a fraudulent Medicare claim in my account. Appears others did too

Post by whodidntante »

Medicare fraud is rampant because Medicare does not have sufficient controls in place to prevent it, and the fraudsters can make off with 100 grand or so before the slightest bit of heat comes their way and they have to setup a new fake medical supply business. A few fraudsters have gone to prison, but that is hardly a solution. The fraudulent claims should never have been paid. I'm pretty sure that United Healthcare (for example) is not firehosing money to obvious criminals as Medicare does. The CEO would have some explaining to do on the quarterly earnings call.

I mean do your duty as a citizen and report it, once. But otherwise I don't see why one should care. This is Medicare's problem, and the loss is shared by all taxpayers. Maybe writing your congresswoman to request that the actual problem be solved would be good if you want to do something. And a letter to the editor, IDK.
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Tubes
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Re: WARNING: I just found a fraudulent Medicare claim in my account. Appears others did too

Post by Tubes »

There is so much hype about AI out there. AMZN, GOOG, MSFT, APPL and others know so much about us.

Yet, the big government agencies are way behind on AI or even good old big data analysis. And perhaps the last post is correct, we should put pressure on our congresspeople to either fund or oversee these agencies to handle these problems... instead of whatever else is occupying them. This fraud is costing us all dearly. Back of envelope calculations show this one incident only is enough for everyone in the USA to get a decent meal at a fast food restaurant.
billaster
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Re: WARNING: I just found a fraudulent Medicare claim in my account. Appears others did too

Post by billaster »

whodidntante wrote: Sun Feb 11, 2024 12:00 pm Medicare fraud is rampant because Medicare does not have sufficient controls in place to prevent it, and the fraudsters can make off with 100 grand or so before the slightest bit of heat comes their way and they have to setup a new fake medical supply business. A few fraudsters have gone to prison, but that is hardly a solution. The fraudulent claims should never have been paid. I'm pretty sure that United Healthcare (for example) is not firehosing money to obvious criminals as Medicare does. The CEO would have some explaining to do on the quarterly earnings call.
Quite the opposite. United Healthcare exploits overbilling to firehose Medicare money directly to themselves, cutting the petty criminals out of the action.

https://kffhealthnews.org/news/unitedhe ... eds-claim/
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whodidntante
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Re: WARNING: I just found a fraudulent Medicare claim in my account. Appears others did too

Post by whodidntante »

billaster wrote: Sun Feb 11, 2024 1:05 pm
whodidntante wrote: Sun Feb 11, 2024 12:00 pm Medicare fraud is rampant because Medicare does not have sufficient controls in place to prevent it, and the fraudsters can make off with 100 grand or so before the slightest bit of heat comes their way and they have to setup a new fake medical supply business. A few fraudsters have gone to prison, but that is hardly a solution. The fraudulent claims should never have been paid. I'm pretty sure that United Healthcare (for example) is not firehosing money to obvious criminals as Medicare does. The CEO would have some explaining to do on the quarterly earnings call.
Quite the opposite. United Healthcare exploits overbilling to firehose Medicare money directly to themselves, cutting the petty criminals out of the action.

https://kffhealthnews.org/news/unitedhe ... eds-claim/
Ha!
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