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Friday, Oct 24, 2014
Letter of the Day

Stop Medicare fraud to control spending

Published:

Regarding “Keep a lid on Medicare spending” (The Washington Post, Other Views, Jan. 22):

I am a grateful recipient of Medicare benefits. This article doesn’t touch on the biggest reason for any Medicare excess spending. At the top of the list, and probably 90 percent of any excess spending, is fraud.

I recently had a claim that is an excellent example. I needed a device to deter my pain previous to a surgery I had scheduled. The device was in stock at the store I tried first and retailed for $59. When the sales person told me they had what I needed, I asked whether they accepted Medicare assignments, and she said they did. So I filled out the paperwork and received the item I needed for my pain.

When I received claim copies from Medicare I found the provider had filed the claim for $209. Medicare approved $139.86, of which $27.86 was charged to me for the co-pay. The provider got away with this by using a modifier code which allows providers to charge over and above the already capped-out benefits for a patient’s treatments. This allowed the provider to be paid almost five times the amount of the cost of the item.

I can guarantee you this provider uses this same procedure for many patients if they think they can get away with it.

I am sure all can see my point here. I am sure this happens thousands of times every day in the United States. So keeping a lid on Medicare spending can be solved by stopping the fraud that goes on every day.

D. J. Holding

Dover

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