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Federal Grant to Combat Health Care Fraud

There are roughly 6.6 million Medicare beneficiaries in Florida. The federal government is now looking to enlist the assistance of that group in uncovering Medicare fraud. The Florida Senior Medicare Patrol was given $400,000 for 2012 by the federal government as part of an anti-fraud campaign. The goal of the campaign is to enlist the assistance of seniors in identifying and avoiding Medicare fraud.

Seniors are being encouraged to review their bills and report anything they regard as suspicious. Through a series of seminars, community events and speaking engagements, volunteers have reached some 54,000 seniors. This program has expanded rapidly since its inception in 1997. Nationwide, nearly $9 million in grants have been awarded to senior patrol groups.

It is not clear what kind of training seniors receive. Spotting real fraud in a billing statement is not always a straightforward matter. For instance, in 2009, only 217 of the 456 situations that were reported as suspicious actually merited reports to federal investigators. At least one report did lead to a criminal conviction. A senior reported seeing regular busing of the residents of an assisted living facility. The group was being paid kickbacks for participating in a mental health program. Paying kickbacks to Medicare eligible patients is a common form of health care fraud.

Medicare fraud prosecutions draw headlines. Prosecutors and federal officials are always looking for new ways to identify fraudulent billing practices. This program gives them an additional tool to pressure medical professionals who treat Medicare beneficiaries. Any bill that looks suspicious to a Florida senior could be reported to investigators.

Source: Sun Sentinel, "Campaign enlists seniors to fight Medicare fraud," Bob LaMendola, 27 November 2011

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