Friday, July 29, 2016

In This Issue

DME & Medicare Fraud: A New Illinois SMP Tip Sheet

Head of Home Health Company in Illinois Sentenced to Six Years for Medicare Fraud

Fraud in the News

The following are current news articles about health care and fraud issues.

Health Care Fraud:

1. "Judge Finds Co-Owner of Chicago Medical Transport Company Guilty of Multi-Million Dollar Fraudulent Billing Scheme" (DOJ)

2. "$42 Billion Saved in Medicare and Medicaid Primarily Through Prevention" (CMS)

Consumer Fraud:

3. "Online Shopping: Tips to Keep Close to Your Wallet" (FTC)

4. "Month of the Military Consumer" (FTC)

5. "New Threats in Ransomware" (AARP)

6. "Multi-Level Marketing: Questions to Ask" (FTC)

Please share this Fraud Alert with colleagues, consumers, or other professionals in your area. If you have any questions about the Illinois SMP program, or to receive these Fraud Alerts directly, please contact Jason Echols, Healthcare Consumer Protection Coordinator at AgeOptions.

This project was supported, in part by grant number 90MP0216, from the U.S. Administration for Community Living, Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official Administration for Community Living policy.

Dear SMP Readers,

This week's Fraud Alert includes a new tip sheet on DME fraud, news of a six year fraud sentence and more in our Fraud in the News section.

Have a great weekend!

DME & Medicare Fraud: A New Illinois SMP Tip Sheet

The Illinois SMP at AgeOptions recently released our newest tip sheet on durable medical equipment (DME) and how Medicare covers it. The front of this two page tip sheet shows a road map for how Medicare covers DME for the people who medically need it. This is how Medicare's DME coverage should work.

Fraudsters do not follow this path because they are trying to bill Medicare for something that you do not medically need. The second page of this tip sheet highlights a story of DME fraud and shares tips for how to spot unsolicited DME marketing. Our final tips are how you can prevent, detect and report fraud!

DME fraud continues to be a very serious problem. If you understand how Medicare is supposed to work, you will be better able to spot fraud.

Image of DME Tip Sheet road map for Medicare_s DME coverage

Illinois SMP's Newest DME Tipsheet

Head of Home Health Company in Illinois Sentenced to Six Years for Medicare Fraud

A federal judge sentenced the manager of a Schaumburg, IL home health company to six years in prison for her role in a scheme to fraudulently bill Medicare. According to the Department of Justice (DOJ) press release, the manager "directed employees to perform in-home visits with patients who were physically capable of leaving their residences and not in need of in-home treatment." She also instructed employees to bill Medicare for more complicated and expensive treatment even though they only provided routine care.

In April, a jury convicted the home health care manager on 21 counts of health care fraud. In addition to the six year sentence, the judge ordered the defendant to pay $15.6 million in restitution. Read more in the DOJ press release.

To qualify for home health care, Medicare beneficiaries must be certified homebound, need skilled care, and have a plan of care. Read more in the Illinois SMP's home health fraud infographic.

AgeOptions Ideogram

Jason B. Echols, MSW,
Health Care Consumer Protection Coordinator
AgeOptions
1048 Lake Street, Suite 300
Oak Park, IL 60301
phone (708)383-0258 fax (708)524-0870
jason.echols@ageoptions.org

ageoptions.org

AgeOptions, the Area Agency on Aging of Suburban Cook County, is committed to improving the quality of life and maintaining the dignity of older adults and those who care about them - through leadership and support, community partnerships, comprehensive services, accurate information and powerful advocacy.

Fraud Alerts contain information about current scams taking place in Illinois, announcements and updates about programs or services related to health care and/or fraud protection, and links to news articles about health care and fraud topics. Please forward any recommendations or announcements that you would like to be included in a future Fraud Alert to jason.echols@ageoptions.org.