Fraud Tip of the Day - May 23

Some Examples of Medicaid Fraud

This is only a partial list of some of the medical-related fraud out there. Many of these types of medical fraud target seniors but anyone can be a victim.

• Hearing Aids - Millions of Americans have trouble hearing. Many could benefit from some type of hearing aid, but some may not. How do you know if you're one of the lucky ones? Once you've decided to try one, you visit a qualified audiologist or seller to be fitted. Make sure you inquire about free trial so that you can test the hearing aid. Ask about and gather information about guarantees and warranties. Make there are in writing and not simply verbal agreements.
  
  Regulations that cover many important aspects of hearing aid sales for consumers are enforced by the U.S. Food and Drug Administration. One regulation requires that you are told about the need for a medical evaluation by a physician before you buy an aid; another requires that aids come with instruction books covering use, maintenance, and repair.
  
  
• Switching Prescriptions - In the past few years, many prescription drug companies have formed business relationships with pharmacy groups and insurance companies that handle drug-benefit plans. In some cases, pharmacies and insurers receive rebates or other financial incentives when they convince a plan member to switch to a different drug made by a "partner" manufacturer. If you are uncomfortable about making a switch, call the Food and Drug Administration, your local Department of Health, or your local Board of Pharmacy. They can help you decide whether it makes sense to change your medication.
  
  Meantime, you may want to ask your pharmacist or physician a few important questions: Will the new drug work as well for your condition? Are there different side effects or risks? Are the dosage levels the same? Is there a business connection between the pharmacist and the drug manufacturer? Will the switch save you or your benefit plan money or cost you money?
  
  
• Nursing Homes - Residents should be able to complain and complaint procedure policy should be clear. If you feel the need to file a complaint, ask a sympothetic staff member how you should go about it. You also may want to ask the nurse in charge to review your family member's care plan. If you still are uncomfortable with the situation, speak to the director of nursing, the social worker, or the administrator or check to see if the nursing home has a family council, a group of advocates who try to improve the quality of life in the home.
  
  Often, nursing homes operated by large corporations have toll-free telephone numbers you can use to speak to a regional supervisor.
  
  
• Alternative Medicines - Many unconventional treatments for cancer and other diseases are on the market. A few have undergone rigorous scientific testing for their curative value. Many that have been tested don't show effectiveness. Still, some forms of alternative therapy are recognized as helpful in caring for patients and helping them cope with some illnesses.
  
  Usually, a primary care physician is the best source of information about alternative medicine as a supplement to conventional treatments.
  
  If someone tries to sell you an alternative treatment by promising that it is effective, ask for a copy of the studies that prove it. Then ask your primary care physician or family doctor to review the studies to determine their credibility.
  
  If you think you've been misled by advertisements for either alternative medicine or conventional treatments, be cautious and complain.
  
  
• Cataract Surgery - Cataracts come with age; they usually develop over time and don't have to be removed immediately. You generally can wait to have the surgery until your vision begins to bother you.
  
  If your doctor says you have a cataract, ask if the surgery can be put off or whether it needs to be operated on immediately. If you're advised to have surgery ask your doctor how risky it is. Are you healthy enough to go through it?
  
  If you're told there's no risk involved or are guaranteed to come out of it successfully, you might want to get a second opinion. Serious complications are rare, but when they do occur, they could result in loss of vision.
  
  
• Arthritis Cures - The U.S. Department of Health and Human Services' National Health Information Center can help you get in touch with public and private groups that have information about traditional and alternative therapies for arthritis and other conditions. Your public library also may have a computer link to provide you with direct access to the National Health Information Center. To learn which products are government approved and which aren't, call the FDA. For the latest information on vitamins and nutritional supplements, call the FDA's Center for Food Safety and Applied Nutrition.
  
  
• Direct-Mail Scams - Many direct mail marketers use trickery to help sell their products. Some disguise their ads by dressing them up as "clippings" sent by unidentified friends. These friends don't exist. The direct marketer got your name from a mailing list and sent the "clippings" to thousands of people.
  
  Disguising marketing materials as checks or official government notices is also a common tactic. One of my favorites involves advertising that arrives in envelopes stamped with the words "urgent" in big red letters.
  
  If the company sending out these marketing materials is using trickery to get you to look at them, how much do you think you can trust the offers inside. Think about it. Report any questionable solicitation you receive in the mail to your local Postmaster or Postal Inspector. Check the phone book for the phone number.
  
  
• Abusive Care-givers - No one should be abused, physically or verbally, by anyone, including family members or care-givers. Everyone has the right to feel safe and secure in their own home. If you or someone you know is being abused in any way, report it. Everyone has the right to be protected.

More Medicaid Scams on Fraud Guides