Patrol getting a grip on fraud and waste [The Free Lance-Star, Fredericksburg, Va.]

<p><chron>Oct. 06</chron>--<person>Dick Shearer</person> kicks off talks about preventing <org>Medicare</org> fraud by asking seniors if they brought along their <org>Medicare</org> cards.</p><p>Most, he said, will raise their hands.</p><p>"I always ask, 'Why?'" said Shearer, a retiree who lives in Falls Run in <location value="LU/us.va.stffrd" idsrc="xmltag.org">Stafford County</location>. "The only reason they should have it with them is if they're visiting a health care provider who needs to see the card."</p><p>If thieves steal a purse or wallet containing a <org>Medicare</org> card, he said, they can sell the victim's <org>Medicare</org> number to a scammer or use it themselves to bill <org>Medicare</org> for medical supplies and services the senior citizen never asked for or received.</p><p>Shearer is a volunteer with the Senior Medicare Patrol, which was formed in 1997 as part of the Older Americans Act and the Health Insurance Portability and Accountability Act. Participants are trained to help educate and empower their peers to identify, prevent and report <org>Medicare</org> fraud, abuse and errors.</p><p>His next program will be held at 7 o'clock tonight at the <org value="ACORN:2407565646" idsrc="xmltag.org">Central Rappahannock Regional Library's</org> England Run branch, <location>806 Lyons Blvd.</location> in <location value="LU/us.va.stffrd" idsrc="xmltag.org">Stafford</location>. It's for the <org>National Association of Retired Federal Employees</org> but will be open to the public.</p><p>"I got interested [in the Senior Medicare Patrol] about two years ago when I started reading about how <org>Medicare</org> fraud and abuse was costing <money>$80 billion to $100 billion</money> a year," said Shearer, whose career included a 21-year stint in the <org>Navy</org>, as well as work for <org>GE Aerospace</org> and Booz, Allen and <location value="LU/us.va.halton" idsrc="xmltag.org">Hamilton</location>.</p><p>"One of the biggest problems that <org>Medicare</org> has had was a policy of 'pay and chase.' Anyone who sent a bill to them, they'd pay. When there was a question of whether they were legitimate, they'd chase," he said.</p><p>Passage of the Patient Protection and Affordable Care Act, the national health care reform legislation passed last year, has made provisions and provided funding to do more prevention. As part of that effort, the Senior Medicare Patrol has launched an advertising campaign about steps seniors can take to head off fraud.</p><p>"Instead of 'pay and chase,' they're trying to prevent, then chase," Shearer said.</p><p>During his talks, Shearer describes several common types of fraud, all of which aim to pry <org>Medicare</org> numbers out of victims. In one, a telemarketer calls, asks how much the senior pays for drugs, and offers to ship all of his or her medications for a one-time fee. In another, the scammer comes to a senior's home, tells him the government wants to make sure he is eating healthily, and offers to give him free milk, eggs and other basics.</p><p>At the end of both ploys, the scammer says that he needs to prove to <org>Medicare</org> that the senior has gotten the freebies, and asks him to sign a statement and include his <org>Medicare</org> number.</p><p>"The biggest thing seniors have to realize is that <org>Medicare</org> does not call them on the phone. <org>Medicare</org> does not show up at their door. If that happens, they should just politely say no," Shearer said.</p><p>To ensure that <org>Medicare</org> is paying only for bills that they actually incur, during his talks he hands out packets that include a Senior Medicare Patrol calendar with spaces to record the date and time of appointments with doctors or health-care providers, co-payments and other information.</p><p>Shearer advises seniors to refer to it when reviewing their quarterly Medicare Summary Notice and Part D Explanation of Benefits or their <org>Medicare</org> account at MyMedicare .gov to make sure the information is correct.</p><p>Seniors should make sure they weren't charged for a visit, medication or medical supplies they didn't receive, billed more than once for something, or billed for services or equipment not ordered by their doctor.</p><p>"In <location value="LS/us.fl" idsrc="xmltag.org">Florida</location>, which has the biggest number of durable medical equipment fraud cases in the country, all you need are an address and a business license, and you're in position to perpetrate <org>Medicare</org> fraud," Shearer said.</p><p>Scammers will open a storefront, buy <org>Medicare</org> numbers online or from the homeless and the poor, then use those numbers to bill <org>Medicare</org> for equipment they have no intention of supplying, he said.</p><p>"People have gotten millions of dollars in a month, then folded up their tent and disappeared," Shearer said.</p><p>Besides prevention talks, Senior Medicare Patrol volunteers also can help seniors figure out if a billing error has been made or if they've been victims of fraud or abuse.</p><p>"Most problems are just plain old errors," Shearer said. "You should call and say, 'Why did you bill me on such and such a date when I didn't see you on that date?' Usually they'll say, 'Oh, I'll correct that.'"</p><p>If the problem is more serious, area residents should first contact either <person>Susan Johnson</person>, SMP project manager for the <org>Virginia Association of Area Agencies on Aging</org> in <location value="LU/us.va.rchmnd" idsrc="xmltag.org">Richmond</location>, at 800/938-8885 or</p><p>Email: <a href="mailto:[email protected]">[email protected]</a>; or the <org>Rappahannock Area Agency on Aging</org> at 800/262-4012 or info@raaa16 .org.</p><p>They can contact Shearer, who can help seniors straighten out errors. If abuse or fraud is suspected, he does some initial investigation, fills out a database and refers the situation to law enforcement.</p><p>"I do this for the satisfaction of helping people and cutting down on fraud and abuse," Shearer said. "I feel outrage that we aren't doing more. This stuff is so rampant it's ridiculous. There aren't enough people to track it down."</p><p><person>Cathy Jett</person>: 540/374-5407</p><p>Email: <a href="mailto:[email protected]">[email protected]</a></p><p class="shirttail">___</p><p class="shirttail">(c)2011 The Free Lance-Star (Fredericksburg, Va.)</p><p class="shirttail">Visit The Free Lance-Star (Fredericksburg, Va.) at www.fredericksburg.com/flshome</p><p class="shirttail">Distributed by MCT Information Services</p>