Q. My husband has Parkinson’s and has been seeing a physical therapist. We have grown to really like this young man, and the PT is helping my husband with his symptoms. But when we got our last Medicare statement, it looked like he has been billing for days when he wasn’t here. What do you think I should do about this? I don’t want to get him in trouble.
It’s completely understandable that you don’t want to get your husband’s physical therapist in trouble, especially if you’ve developed a good relationship with him. But it’s also important to know that billing Medicare for services that weren’t actually provided, even if it seems like a small issue, may be considered Medicare fraud or abuse.
You’re not alone in this, it’s estimated that Medicare loses about $60 billion each year due to fraud, errors and abuse. That kind of loss affects us all, because it takes money away from the care we really need.
This week is Medicare Fraud Prevention Week, which is a good reminder that we all have a role to play in protecting the system. The Massachusetts Senior Medicare Patrol (SMP), which helps educate people on Medicare fraud, waste, and abuse, recommends taking the following steps when you think fraud or abuse may have occurred:
Check your statements: You have already taken the first step in addressing the issue by checking your Medicare statements. All Medicare beneficiaries should know how to read their Medicare Summary Notice or Explanation of Benefits.
Double check your statements and make a list of the dates and services that don’t match what actually happened.
Sometimes it’s an honest mistake, but repeated errors could be a red flag.
Contact the provider: If your husband’s physical therapist is connected to a clinic or other medical office, give them a call. Let them know you have a few questions about the visit schedule. They may not be aware of the issue, and it gives them a chance to make things right.
Report concerns: If you still have questions, contact the Massachusetts SMP to report your concerns. You can reach them by emailing ReportAScam@MASMP.org or by calling 800-892-0890. They can help you go through your statements, understand what’s going on, and take the right steps from there.
The Massachusetts SMP Program also offers free personal health care journals that can help you keep track of visits from your husband’s physical therapist and any other medical appointments. To request a free copy of the SMP My Health Care Tracker, email Info@MASMP.org.
Remember, raising a concern doesn’t mean you’re accusing anyone. It just means you’re doing your part to make sure Medicare is used the right way. And that helps protect your care, and the care of others, too.
Are you caring for an older adult or need help finding healthy aging resources? Our experienced staff is available to help. Visit us online at www.agespan.org. You can also call 800-892-0890 or email info@agespan.org.
Joan Hatem-Roy is the chief executive officer of AgeSpan, which serves Andover, Groveland, Haverhill, Lawrence, Methuen and North Andover.