Avoiding Medicare Fraud During Open Enrollment Season

Are you a Medicare beneficiary? If so, then this is the time of year when you can change your health and prescription drug plans. But watch out! The Centers for Medicare and Medicaid Services (CMS) report that fraudulent activities increase dramatically during this period.

Elderly are unfortunately common victims of Medicare fraud.

According to Golocalprov.com, “billions of American taxpayers’ dollars are wasted on improper payments to individuals, organizations and contractors.” These benefits are paid out to the wrong person, for the wrong reason and in the wrong amounts. A whopping $98 billion in improper payments—with more than half coming from Medicare and Medicaid—were made in 2009 alone. Thanks to the dedicated efforts of almost 25,000 volunteers across the United States, however, millions of Americans have been learning about Medicare fraud and helped prevent it since 1997.

Sadly, not every senior who needs this information gets it and falls prey to fraudulent schemes. If you are a Medicare recipient or know someone who is, here are some easy ways you can help prevent Medicare fraud:

  • Keep your Medicare number private—treat it as you would your Social Security and bank account numbers.
  • If someone you don’t know contacts you and asks for personal information, don’t give it to them. Remember that it can be used for fraudulent purposes.
  • Beware of people claiming to be a Medicare representatives who ask for your Medicare number. Real Medicare officials “wouldn’t need to ask and they wouldn’t call or visit unless call first.”
  • When you receive your Medicare summary notice, make sure the figures posted tally with all the expenses you have accrued for that month.
  • Don’t hesitate to report any suspicious activity to the Office of the Inspector General in your state.

Maintaining awareness is key to staying protected. But if you do find yourself in the position of Medicare fraud victim, a competent lawyer can help you regain both your good name—and your long-term security.

Texas Medicaid Fraud: A Dark Part of a Darker Picture

Below is an excerpt, and a link, to an article about the astonishing amount of Medicare and Medicaid fraud perpetrated yearly in the United States.

One of the areas The Barrera Law Firm specializes in is this type of fraud, perpetrated to the tune of billions of dollars each year.

Some key points on Medicare and Medicaid Fraud:

  • Medicare and Medicaid lose at least $87 billion per year to fraudulent and otherwise improper payments
  • Approximately 10.5 percent of Medicare spending and 8.4 percent of Medicaid spending was improper in 2009
  • Every year since 1990, the U.S. Government Accountability Office has released a list of federal programs it considers at a high risk for fraud. Medicare appeared on the very first list and has remained there for 22 straight years. Medicaid assumed its perch eight years ago.

Read all of “Entitlement Bandits” here.

Considering the state of the U.S. economy and the need to reduce runaway debt, Medicare and Medicaid fraud needs more than just an article or two written about it, it needs people who know of this fraud to bravely step forth and decide to do something about it.

A Whistleblower’s Short Guide to Reporting Pharma Fraud

Are you a drug rep that feels that your company is doing something wrong?

Are you a doctor that is worried about how a “motivated” drug rep may be putting you in a bad position with the law?

Whether you are a medical provider, a sales rep, or executive for a pharmaceutical company or lab, you must be aware that the government can seek you out for criminal and/or civil penalties if you participate in any scheme as outlined below.

Examples of Pharma Fraud Schemes

Kickbacks: Giving medical providers money, gifts, lavish entertainment, “consulting fees”, “grants” or other benefits to change a person’s prescription to the sales rep’s product or “to gain their business” when the drugs are paid for by government programs.

Off-label marketing: Promoting drugs to doctors that are billed to the government for ailments that the drugs are not approved to treat, unless the claims are backed up by real studies that are not meant to mislead.

Selling Free samples: Encouraging medical providers to bill the government for free samples and those samples clearly indicate that they are not to be sold.

Price Fixing: A general scheme of inflating prices of drugs so that more money is billed to the government.

Why be a Whistleblower?

You may be both rewarded through monetary compensation and shielded from criminal and civil penalties if you do the right thing. Federal and state law rewards and encourages individuals to blow the whistle on any scheme meant to defraud government programs such as MEDICARE, MEDICAID, and TRICARE.

Call The Barrera Law Firm at 956 428 2822 for a free and confidential consultation to answer all of your legal questions.