Preventing Medicare Fraud By Raising Awareness

By Briana Vannozzi

Charles Clarkson leads a small team of volunteer investigators who might just be medicare’s best kept secret.

“We use federal funds to basically educate seniors throughout the state so we can protect them from medicare fraud, waste and abuse,” he said.

Clarkson is the statewide coordinator for New Jersey’s federally-supported Senior Medicare Patrol Office. It’s one of 50 throughout the country seeking to fight a pervasive problem: medicare fraud. By low estimates, it costs tax payers around $60 billion a year.

“If you throw in medicaid and you throw in private insurance, we could be losing, according to the FBI, $1 for every 10 spent on medical services and that could be as high as $250 billion a year,” Clarkson said.

Clarkson’s office, housed at the Jewish Family and Vocational Services of Middlesex County has a tip line to answer questions and open cases for potential abuse. He says the most common source of fraud comes from billing for services never provided. That happens because there’s no third party, other than the patient, to check a medicare bill once it’s submitted.

“The next one would be up-coding, where the provider puts a higher code than the one actually provided so he gets more money, such as an X-ray compared to a CT scan,” he said. “Of course there’s always double billing where basically a provider bills a beneficiary twice and they get paid twice.”

“The typical cases that we see are probably maybe $200-$300, something like that. But some of these others can reach into the thousands,” said Ed Campell.

Campell is the Coordinator for Complex Issues. He says it’s the small issues that add up — and often the ones beneficiaries don’t think to report.

“People use doctors for a long time, and even if they suspect their doctor is cheating they’re very hesitant because then they know they would have to change doctors,” Clarkson said.

It’s another scam on the rise.

“People are getting calls from companies that sell knee braces, back braces and saying we can get you one for free,” Campell said.

But the office stresses, medicare will never call you or ask for personal information. They advise people to just hang up.

“But people will be very polite. We’ve gotten calls from people who have given out their social security number, their medicare number, their birth date and they shouldn’t do that. Just hang up the phone,” Campell said.

The lifeblood of this organization is a group of highly trained volunteers who help carry the message out to the community.

“They’re all professionals, most of them retired. They’re strong in research and they have strong people skills,” said Phyllis Freed.

They’re always in need of more. Clarkson travels around giving free presentations. Recouping the money can take months and years — a job done by the Inspector General or U.S. Attorney — so prevention is his main tactic.

“The first tip we always give is to read your medicare notice summary carefully. Just because medicare paid it, doesn’t mean it’s right,” Clarkson said.

He also stresses beneficiaries should keep track of their medical appointments and tests, and if they have any doubts to call his office.