How the Senior Medicare Patrol can help reduce fraud

Feb 7, 2014 | Healthcare Accounts Receivable

Across the United States, millions of people over 65 years old benefit from Medicare's services. The government-funded program allows older citizens to obtain the care and prescriptions they need. While this program is intended to be a valuable resource for senior citizens, about $68 billion from Medicare is lost within the health care system due to fraud, the Miami Herald reported. 

One way Medicare has tried to lessen the likelihood of fraud is through the use of the Senior Medicare Patrol (SMP), which consists of volunteers educating other senior citizens about the risk of defrauding Medicare.

"It's a responsibility we all have, not only to ourselves but also to others," retired pharmaceutical executive and volunteer Joe Schwartz told the source. "If funds are depleted, if they're spent on paying bogus claims, what's going to be left for our children and even our grandchildren?"

The challenge with Medicare fraud is that it may not be as simple for accounts receivable management to identify these problems. Because this specific patient population may rely on an array of prescriptions and preventative medicine services, challenging some of these requests may cause a problem for patients.

However, with the support of SMPs, these volunteers are doing their part to educate Medicare beneficiaries and finance departments, so everyone is more aware of the structure of these scams. With this knowledge, accounts receivable departments will be able to identify billing errors and fraudulent activity.

In Florida alone, Medicare fraud is a $3 to $4 billion problem. Recently, the Department of Justice was able to restore over $28 million back into the system once it realized that a chain of rehabilitation clinics were created to take advantage of Medicare disbursements, according to the Herald-Tribune.

It is unclear if the discovery of perpetrator Luis Duluc's facilities were the result of the SMP program, but it explains one thing: auditors are becoming more aware of Medicare fraud. Duluc's illegal activity may cause him to face up to 15 years in prison.

Hospitals that have a collection of outstanding medical bills, but are unsure how to file these payments can benefit from medical claims management. These professionals can figure out how these bills will be processed, bringing back more revenue back into the practices.