Todd ... here I will get to what I found out is happening more and more AND in one doctor's office in particular (further below my first-hand experience which I talk about first) regarding Medicare fraud or theft. Same difference.
I know long e-mails are laborious to read but I hope that many of you DO read this for yourself, for your parents, for your grandparents or whomever who will probably, in some way and some time, fall into these traps. FIRST THOUGH -- Here is one of my first-hand case scenarios with a doctor's offices getting away with double dipping *Medicare *and getting away with it. I had a primary care physician here four years ago. My husband was also a patient of his. Had him abt 2 yrs. Neither of us go to the doctor's office that much but it does not even have to take that to let me/us see what is going on. Whenever I DID go ... I would receive their bill and what they billed *Medicare* for. And then I would have to wait for CMS's Medicare's Explanation of Benefits to see what my responsibility of the bill was. Well, the last bill I received from this particular doctor (for a visit of mine) was so screwy you could not even read what was what. My husband called and asked for a bill that was more itemized and readable. They disagreed that there was anything wrong with their billing statement. Heanen forbid! My husband called because he is better at dealing with people... especially those that are trying to lie to your face. The other problem we saw was that the bill was SO VERY screwy but it was also set up to be able to *double dip* in getting Medicare payments. In other words... getting paid twice by Medicare. I get a tiny bit of help from a home health agency paid for 100% by MediCARE. I'm getting robbed of over 98% of what I am eligible for but that is an entirely different story. Anyway, every 65 days I have to be recertified to make sure that I am still a quadriplegic (ha ha - ho -ho) and still in need of home health help. The home health agency sends my physician a sheet of paper for him to sign and date that I am still in need of services every 2 months for this recertification. And that is ALL a physician has to do... sign one and date one. Every 65 days. MEDICARE, for approximately the last six years now, *has allowed physicians to bill Medicare for their signatures!!!* And it is not just a small amount. It is close to $200 or more! Absolutely crazy! But that's the federal government for you! But it gets worse. What is so ironic is that *Medicare *has a fraud hotline. But it is a joke. They are also federal government employees and nothing gets done even if it is reported. Anyway, when we noticed on the bill that my doctor's office was billing Medicare twice for my 65 day recertifications over a 9 month period ... I again asked for an itemized, readable bill. The bill was a mess *but that was to throw off* Medicare fraud being perpetrated by doing this. When my husband asked why their office was billing Medicare twice -- they had a fit to be called on it. No surprise there. And then the billing clerk accused my husband of accusing them of *Medicare *fraud. Which he never did. I might as well say here that... guess who we found out his billing clerk was (later via the receptionist)??? HIS MOMMY!!! GET THIS - by this last action of ours (questioning the bill) - it was not a week later where we got a letter from the physician's office saying that we "had breached the patient/doctor relationship" and that we needed to get new doctors within two weeks! *DUMPING BOTH OF US* because of questioning their billing! This is the honest to God's truth and, since then, I have found out that this type of of thing is running rampant. I will tell you how I found out next. OK ... NEXT ... :-) Approximately 2 months ago when my home health nurse was here to change my catheter... we began talking about Medicare fraud and I told her what happened to us four years ago. She was not surprised in the least. First of all, MOST *MediCARE* recipients and patients are people over the age of 65. And it is the elderly who are the meek and never question anything for fear of losing what they have. Or they are usually easily more conned by these *Medicare* Dr. con artists. They trust their doctors, the billing, and just pay their bills. So here is what I nurse told me: She told me this was not the first story she heard of such events. IN FACT she told me *that what happened to me* (inquiring about their bill and then being told that they had breached the patient-doctor relationship and to have to find new doctors) had just happened *to one of her other patients*ON MEDICARE. An elderly person. But she told me one MORE thing that was very disturbing to both her, and then after telling me, very disturbing to me. Because of one of her patient's experiences she found out that there is DEFINITELY one doctor's practice here in town that ONLY accepts *Medicare* patients. Hmmmm... wonder why? Obviously, most of the patients are over 65 and don't question bills. Padding their pockets nicely. My nurse told me that she had been familiar with this particular doctor's office [of probably three physicians] and would never have suspected that they would be doing what happened to her patient of theirs like another practice did to me. People can complain until they are on their deathbed. I have been calling about Medicare discrimination and fraud and all one gets is the run-around. Doctors have become wolves in sheep's clothing and getting richer and richer and richer off the disabled and elderly ON *MEDICARE.* Last August, an emergency room doctor's office tried to get away with pretty much the same thing by FIRT billing me directly and not *Medicare!* Which is always the protocol - billing *Medicare* first. The office clerk tried to tell me that I was responsible for the bill and other garbage* but I was not going to buy it/fall for it.* Much later I did get a CMS statement and he billed Medicare for two different things! The bill that was sent to me was $128. When I told them I was not responsible for that full payment and they had to go Medicare (which they already know but are trying to pull the wool over people's eyes with any story) she backed off. THEN I saw that he had billed *Medicare* for $368 for one thing and a smaller amount for another thing. So doctors, hospitals, clinics, etc. are definitely getting paid more by the *Federal Medicare* program but it is the feds to set it up that way to begin with! I was flabbergasted when I found out that they started allowing physicians to bill them a hefty amount for just a signature and a date. Lori -- Lori C4/5 complete quad, 28 years post Tucson, AZ
