Medicare fraud: Check your EOBs

Dear editor, Recently I received an Explanation of Benefits from CHAMPVA, which provides my Medicare gap policy. On it I found $6, 200 of charges from a company called Pretty in Pink Boutique. These charges appeared as identical $1, 550 charges for each of four consecutive months.

I couldn't tell where the company was located or what the medical device billed for was, but it looked to be for urinary catheters. I called Medicare, and the agent told me that the charges were fraudulent and that Medicare had been experiencing a high number of fraudulent claims during the open enrollment period, many of them for urinary catheters. Please note that neither CHAMPVA nor Medicare paid any part of these charges.

In an article of September 2023, Forbes reported that taxpayers are losing more than $100 billion a year in Medicare and Medicaid fraud. Most of this fraud is largescale and organized, often committed by health care practitioners through corrupt billing practices. Much is done by criminals skilled in fraud.

This year, both CNBC and NPR have done detailed investigative reports on such crimes. When I googled Pretty in Pink Boutique, I found fraud complaints against the company on the Better Business Bureau website for El Paso, where a company by that name is located. As it turns out, this is a legitimate company that provides prosthetics for those who have undergone mastectomies, and they have a web page explaining how to report insurance fraud and are adamant that they are not the ones doing this billing.

It appears that not just individual, but also company identities can be stolen for the purposes of fraud. The list of victims in these crimes includes anyone who pays or has paid federal taxes, companies whose names have been usurped for criminal purposes and the government itself. One convicted fraudster attributes his and other criminals' success to the lack of adequate agents to address these crimes.

For now, what can we as individuals do to reduce such fraud? We can read our EOBs carefully and call our insurance providers to report any charges that we can't account for. We also need to support those public officials who are willing to support programs like Medicare with adequate funding for agents to investigate and prosecute wrongdoing. To report Medicare fraud call 1-800-447-8477. (s) Sharon Bookwalter Silver City