Fighting Medicare Fraud in Pennsylvania
Each year billions of dollars are lost to Medicare and Medicaid fraud. The cost is estimated to be over $19 billion annually; however, the cost in terms of loss of quality of care is immeasurable.
CARIE, as a part of its mission to improve the quality of care older people receive, began the Pennsylvania SMP program (PA-SMP) in 1997. The APPRISE programs of both the Mayor's Commission on Aging and Premier Years at Albert Einstein Health Care Network, The Retired Senior Volunteer Program (RSVP), AARP Pennsylvania, and the local Area Agency on Aging, Philadelphia Corporation for Aging, have partnered with CARIE to make the project a success.
The Administration on Aging (AoA), a division of the US Department of Health and Human Services, developed a program to help consumers understand more about health care fraud. Retired Medicare beneficiaries teach other Medicare and Medicaid beneficiaries about health care fraud and what they can do about it.
Fraud occurs when an individual or organization deliberately deceives others in order to gain some sort of unauthorized benefit. Medicare/Medicaid fraud generally involves billing for services that were never rendered or billing for a service at a higher rate than is actually justified. Health care abuse occurs when providers supply services or products that are medically unnecessary or that do not meet professional standards.
For example, Mrs. Jones* called CARIE when she read her Medicare Summary Notice and discovered a home health visit that she had never received. Mrs. Jones' call resulted in an investigation and the recovery of over $66,000 - one person can make a difference.
If you have questions or concerns about health care fraud, are interested in volunteering, or would like to schedule a free speaker, call the PA-SMP at 215-545-5728 or 1-800-356-3606.
* name changed for confidentiality