Combating Medicare fraud
Volunteers educate fellow seniors
“What her information does for us is give us one more potential witness in a particular case.” W.W. ‘Bill’ Root, assistant special agent in charge of Louisiana investigations for the Office of Inspector General
Louisiana retirees are volunteering services that hand federal investigators and prosecutors about eight potential witnesses in Medicare fraud cases annually, officials in Baton Rouge said.
These volunteer members of the Senior Medicare Patrol, many of whom had professional careers before retirement, regularly speak to groups of older residents about the need for safeguarding their Social Security and Medicare numbers from criminals.
“We probably average eight to 10 good referrals from the Senior Medicare Patrol every year,” W.W. “Bill” Root said at his Baton Rouge office. Root is assistant special agent in charge of Louisiana investigations for the Office of Inspector General, U.S. Department of Health and Human Services.
Julie Mickles Agan, manager for Louisiana of the patrol, also known as the SMP, said many of those criminal-case referrals have resulted from questions Medicare beneficiaries raised during community meetings in which SMP volunteers spoke and distributed helpful literature. Agan works for eQHealth Solutions, a Baton Rouge firm that has received grants from the U.S. Administration on Aging since 2009 to manage SMP programs in Louisiana.
“We can turn these cases over because we’re out in the communities,” Agan explained. She said some other SMP referrals are made to law enforcement because of information received at a toll-free number, (877) 272-8720. Other people contact SMP staff by email at lasmp@eqhs.org, Agan added.
“The phone is answered by a human being,” Agan said.
“We have about 42 SMP volunteers statewide, and we’re always looking for more,” Agan said. She said those volunteers speak at Council on Aging meetings, assisted living facilities and a variety of community outreach events.
“We have gone everywhere, all of the 64 parishes,” Agan emphasized.
“What her information does for us is give us one more potential witness in a particular case,” Root said.
He said information from potential witnesses sometimes is used by prosecutors in pre-trial negotiations that can result in guilty pleas. Some people actually testify, either at trial or at a defendant’s sentencing hearing.
Root said others simply provide information that is helpful to investigators.
Root’s office, the FBI, investigators from the Louisiana Attorney General’s Office and members of the local U.S. Attorney’s Office have worked with the Baton Rouge Medicare Fraud Strike Force since December 2009 on alleged crimes totaling $73.1 million.
Court records show $18.2 million of those Medicare losses have been proved at trial or through guilty pleas. An alleged home health-care fraud of $17 million is scheduled for trial Oct. 1. And alleged frauds totaling $37.9 million for outpatient psychiatric services are to be tried in Baton Rouge at a later date.
Pending fraud cases in other Louisiana cities include allegations of yet another $17 million in Medicare losses.
A blank check for criminals
Louis Saccoccio, executive director of the National Health Care Anti-Fraud Association, estimated last year that health-care fraud of all types annually totals between $75 billion and $250 billion in the United States. Saccoccio’s estimate was included in a statement he made to the U.S. House Committee on Ways and Means’ Subcommittee on Oversight. The NHCAA is a group of more than 100 private insurers and government agencies.
In Baton Rouge, Root said, such loss estimates highlight the importance of civic-minded groups such as Agan’s SMP volunteers.
“When they address seniors, they’re telling them to protect that Medicare number,” Root said. “It’s a blank check in the hands of criminals. What they (SMP volunteers) do is very valuable. We have to have the public’s cooperation and assistance to prosecute these cases.”
Added Agan: “A Medicare number is more important to a thief than a credit card. A credit card has a very short shelf life. It’s very hard to cut off a Medicare number.”
That’s both financially and physically dangerous, Agan added. She said criminals often defraud Medicare in ways that escape detection by innocent beneficiaries who do not suspect the thefts until they need emergency or other important medical services.
“Criminals will screw up your medical records,” Agan added. “Five years from now, when you’re rushed into an emergency room, you may be treated as a diabetic, when you’re not diabetic,” she explained. “That can be life threatening.”
Agan explained that such health threats occur when a criminal uses the stolen identity of a Medicare beneficiary to bill the system for diabetic treatments and medicines that were never delivered. Medicare’s records falsely show, however, that the patient is diabetic.
Knowing participants in such crimes can include owners of medical equipment companies, doctors, nurses, clerical workers at clinics and hospitals and patient recruiters. People in each of those groups have been convicted on felony charges since the Medicare Fraud Strike Force was established in Baton Rouge.
Beware Dr. Evil
Dr. Harold “Skip” Ishler, 71, of the Forest Ridge subdivision in Livingston Parish, is acutely aware that “a few doctors have been doing unethical or illegal things.”
Retired since 2007, Ishler said he regularly serves as a SMP volunteer speaker to senior citizens in groups ranging from 10 to 60.
“I always wear my stethoscope,” Ishler noted. “And I bring some handcuffs that I slap on myself. I tell them: ‘This could be your doctor on television tonight.’”
Ishler is no criminal. He was a respected family physician. He said he uses his stage props to shock audiences into checking their medical bills for services not rendered or treatments and equipment never prescribed.
“Never give out your Medicare or Social Security numbers over the phone unless you initiated that call to one of your medical professionals,” Ishler urged.
Agan noted: “Medicare doesn’t knock on your door or call you on the telephone to sell you something. Medicare doesn’t call you to ask for your Medicare number, either.”
SMP volunteer Pauline Fernandez, 72, of Baton Rouge, was an accountant who worked decades for state, parish and city government agencies.
“I kind of missed working,” Fernandez said. “I saw a Smiley Anders column that said volunteers were needed to spread the word to Medicare seniors. I think it’s important to spread the word, so I volunteered.”
Each SMP meeting with senior citizens includes hand-out packets of helpful information that are put together by volunteer Ann Nauman, 81, of Baton Rouge.
“I’m the go-fer. I answer the telephone,” said Nauman, professor emerita at both Southeastern Louisiana University in Hammond and St. Joseph Seminary College, north of Covington.
“I volunteered as a result of a letter that Julie wrote to the newspaper,” Nauman said. “I wanted something I could do every day or at least two or three days a week.”
Nauman said she is proud of her service because “SMP is doing this very well, getting the word out to folks.”