AUSTIN (KXAN) – Valerie Bennett rarely goes to the doctor, and she’s never had diabetes. So, it came as a troubling surprise when she noticed hundreds of dollars in diabetic supplies billed to her Medicare account and supplemental insurance in September and October.
Bennett tried multiple times to call the San Antonio company listed on the billing summary. She had never heard of the company before seeing it on her bill. She said she never got a call back, so she reported the charges to the Centers for Medicare and Medicaid Services, or CMS, and sent an email about her experience to KXAN investigators.
“I was angry because that’s taxpayer money, and we all pay for that,” Bennett said. “That’s just wrong to use a system like that.”
Bennett said she hopes exposing the problem could spur people to report erroneous bills that might be Medicare fraud. Her charges appear to be a facet of the vast and lucrative nationwide industry of improper Medicare billing that costs billions in taxpayer dollars each year.
Complaints across Texas
Bennett’s complaints were not alone. KXAN obtained 10 other complaints filed with the Texas Office of Attorney General specifically citing charges from July through October from the same business. All the complaints note similar problems – diabetic testing supplies costing roughly $300 or $700 billed to their Medicare accounts. KXAN tracked down four of the people who complained, and all said they filed complaints with the fraud department of CMS.
Linda Ferguson, of Waco, said she, too, was billed for diabetic supplies she never ordered from the business. Ferguson wondered how her Medicare information got out.
“I’m old, but I keep my brain going, so my mind is like a steel trap, but what about the people that have nobody to turn to in a situation like this?” Ferguson said. “That bothers my heart.”
KXAN reached out to the last owner listed on the company’s filing with the Texas Secretary of State. A representative of the company responded and said the original owner sold the business in May 2022 – prior to the dates of improper billing noted in the complaints. The business representative also provided a sales agreement and wire paperwork showing the business had been sold. KXAN could not reach the New York-based buyers noted in the sales agreement.
A CMS spokesperson would not confirm or deny any investigation into the business.
“To protect the integrity of the investigative process, CMS doesn’t comment on complaints and rarely comments on specific cases,” according to CMS. “Medicare fraud and abuse can happen anywhere, and usually results in higher health care costs and taxes for everyone.”
The cost of Medicare fraud
To understand if the business was still operating, KXAN visited the storefront in San Antonio. The business sign remained in place in early December, but it appeared shuttered. The store was locked, the lights off and the shop empty except for a computer monitor on the front desk and some health and pharmacy certificates pinned to the wall.
Jennifer Salazar, Executive Director of Texas Senior Medicare Patrol, said anyone could be behind the billing problems.
“Medicare fraud has been around since Medicare started in 1965. Every single year, we lose $60 billion in Medicare fraud error and abuse,” Salazar said.
Texas Senior Medicare Patrol is funded by federal grants through the Better Business Bureau of Houston. It assists Medicare recipients in reporting Medicare billing problems.
Medicare receives over 4.5 million claims per day, Salazar said, so it is up to recipients to spot and report possible fraud. She said people need to read their quarterly “Medicare summary notices,” or, if they use Medicare Advantage, their “explanation of benefits.”
How to protect yourself
“You need to look through there and if you see anything that looks wrong like you don’t recognize the doctor; you’re not a diabetic, but you’re getting diabetic supplies. If you didn’t order a knee brace, and you’re getting a knee brace, you need to call the Senior Medicare Patrol immediately and we can help you with that issue,” Salazar said.
Right now, she said they are seeing a spike in billing problems involving durable medical supplies, like equipment for diabetics.
Speaking generally about methods of how these problems can arise, Salazar said people potentially trying to take advantage of the system will use everything that’s on the Internet.
“They will steal logos, billing addresses, doctors’ names. They’ll forge signatures. They will steal company names. They’ll do a lot of that to basically come up with fake claims,” she said.
Salazar said her organization gathers information from people who suspect improper billing and sends it to authorities. It can take years for investigators to find and hold those responsible accountable, she said.
The most important way to prevent billing problems, and protect yourself, Salazar said, is to report questionable claims and never give out your Medicare number. She added that you can reach a person at the Texas Senior Medicare Patrol Hotline at 1-888-341-6187 if you have any questions.
CMS recommended all Texans take the following measures:
- Never accept medical supplies from a door-to-door salesman.
- If someone comes to your door claiming to be from Medicare, remember that Medicare and Medicaid do not send representatives to your home.
- Never give your Medicare card, Medicare number, Social Security card or Social Security number to anyone except your doctor or people you know should have it.
- Remember, nothing is ever “free.” Never accept offers of money or gifts for free medical care.
- Be wary of providers who tell you that the item or service isn’t usually covered, but they “know how to bill Medicare” so Medicare will pay.
Bennett hopes sharing her experience can be a warning to others. She said she didn’t have to pay what the bill said she owed.
“I just don’t like people being taken advantage of,” Bennett said. “I want to see … something done about this. I don’t want to just sit there and do nothing.”