Fraud Tip of the Day - May 23

Some Examples of Medicaid Fraud

• 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?
  
  
• Switching Prescriptions - Every nursing home should have a complaint procedure policy. If you have concerns or complaints, ask about the policy and follow the organization's procedures. 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 are a normal part of aging; 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 tells you that you have a cataract, ask whether you need surgery right away, what your risks are based on your general health, and what type of surgery may be appropriate for you, should you choose it.
  
  Be suspicious of any promotion promising completely successful, risk-free cataract surgery. Cataract surgery has a very high success rate, but no surgery is free from risk. 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 check on whether a product is "government approved," to learn more about an over-the-counter drug, prescription drug, cosmetic, or medical device, or to report an adverse reaction to any of these products, call the Food and Drug Administration's Consumer Affairs Information Line. For the latest information on vitamins and nutritional supplements, call the FDA's Center for Food Safety and Applied Nutrition.
  
  
• Direct-Mail Scams - Some direct-mail marketers advertise their products through ads disguised as "clippings" sent by unnamed "friends." The fact is that R doesn't exist. The company got your name from a mailing list and sent the note from R to you and thousands of other consumers.
  
  Other popular tricks are to design the envelope to look like a check or letter from a government agency, or to mimic the style of urgent overnight mail deliveries.
  
  If a company uses a deceptive tactic on the outside of an envelope, be skeptical about what's inside, too. 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