Rona McNally is the director of the Missouri Senior Medicare Patrol, which helps patients prevent and report Medicare fraud. It’s estimated that nationally, Medicare losses $60 billion a year to fraud, errors and abuse.
McNally spoke about how Medicare fraud impacts insurance costs and the quality of healthcare for patients, as well as shared a few ways folks can keep themselves safe from scammers.
Missouri Health Talks gathers Missourians’ stories of access to healthcare in their own words.
Rona McNally: The estimate is about $7 million an hour we're losing to fraud. So, if we can cap that loss, we can extend the life of the program, and it's not just that – it's about quality health care. People who are out to cheat the system, don't all always give quality health care.
Oftentimes it's like Whack a Mole where you stop one scam over here and another scam pops up over here in another place. Something can start in New Jersey, and once they catch on to it there, it's moves here.
The big one is genetic testing. Genetic testing is covered by Medicare in very, very limited circumstances, but we have people doing cheek swabs and telling people that it's a Medicare preventive service, and it's not.
New Medicare cards has been a real problem – where, in order to protect seniors and individuals, the number has been changed from what was their social security number to now a non-identifying number.
But scammers are calling saying they're with Medicare and they need your – “Your new card’s going to expire,’ ‘We need to send you a new one,’ or ‘We'll send you a laminated one.’
So, we have a lot of people getting calls, wanting their Medicare number.
Durable medical equipment – selling people braces and supports that are not needed, equipment that are not needed or ordered by their physician.
So, we have certain things that we tell people to do. We want them to guard their card. Don't give that information to anyone over the phone that calls them and asks for it.
Read the statements that come in, and make sure that the doctor ordered what was received, that they haven't been billed twice for it, and that they actually did receive what was billed.
And then we want them to report to us if they have any concerns.
I will not tell you that we uncover fraud every day. Sometimes people are just uncertain, or they need an explanation as to why something happened.
We also want to reassure them that if people are out to scam you, you're not stupid. If you fell for it, that's what they were trying to do.
Laughter
But we can help them report it.
We work with investigative agencies, and it's important to report things, because if we can build a pattern – let's say that there was a $20 fraud and that is probably not going to get an investigator's attention – but if we can gather several of them, they know there's a problem going on, and it brings it more to the forefront.
So, that's why it's so important to report.
