Bogus Charges

In 2007, an investigative reporter at a TV station in Palm Beach called
Gaddis about beneficiaries who were complaining about bogus charges on
their Medicare Summary Notices (MSNs). Most hadn’t known about the
charges until they needed certain medical equipment, which was denied.
The charges would be billed a couple months in a row, stop, and then
start six months or so later.

After the station aired the story, it was flooded with calls from
people with similar experiences. It hosted a forum on the topic, and
Gaddis was a panelist. “Almost everybody that stood up had over $9,000
or $10,000 worth of fraudulent claims on their Medicare accounts,”
Gaddis says. Beneficiaries now receive MSNs monthly instead of
quarterly in Florida.

In the last two years, a Medicare Fraud Strike Force has indicted 196
defendants who are alleged to have billed Medicare more than $600
million in fraudulent charges. The strike force is supervised by the
U.S. Department of Justice Criminal Division’s Fraud Section and U.S.
Attorney R. Alexander Acosta of the Southern District of Florida.

Gaddis has noticed the difference that the Medicare Strike Force and
other outreach efforts have made in South Florida. “They’re really
cracking down on [fraud]. I would say that within the last year, the
call volume has gone down quite a bit, because half of my calls were
coming from the South Florida area,” Gaddis says.

CMS has revoked the billing privileges of more than 1,100 medical
equipment suppliers in South Florida. In addition, when the majority of
calls to a hotline for infusion therapy fraud turned out to be about
DME and other fraud, CMS opened the hotline to take all fraud-related
calls.

Gaddis partners with (groups) that can help her spread the word about
fraud and abuse. Of particular note is the Seniors vs. Crime Project, a
program of the Florida attorney general in which seniors become
involved in consumer protection prevention, detection, and
investigation. “When we went statewide, I was trying to find volunteers
that were already in place,” she says. The group, with its troop of
Senior Sleuths, has a hotline and storefront locations that allow for
one-on-one help. It helped Gaddis grow statewide quickly.

Colón has seen the work that Gaddis and her volunteers do and is a big
fan. She especially appreciates how they take the time to provide
one-on-one attention to beneficiaries. “I think it’s a great program.
It’s educational. They should be in everything. I am pro that program.
It gives people what they really need down here,” she says.