AUSTIN (KXAN) – Following a KXAN investigation into improper Medicare billing allegations leveled against a San Antonio medical supply company, numerous other viewers emailed tips alleging identical instances of Medicare billing problems that trace back to different companies in other cities.

The viewers – including Ron Kercheville of Bee Cave – say their Medicare accounts and supplemental insurance were billed roughly $300 to $711 for diabetic supplies, namely glucose monitors. The items were never needed, ordered or received. Kercheville’s bills came from a company in Hutchins – south of Dallas. Other viewers said they received questionable bills from an operation in Tomball – north of Houston.

‘Cash cow’

Kercheville said he noticed the improper billing in August and September and reported it to the Centers for Medicare and Medicaid Services (CMS). Then Kercheville did some investigating of his own. Through Nextdoor, a social media app that connects people living in nearby neighborhoods, he found dozens of neighbors voicing similar concerns.

“I began making notes of all these people’s cases,” Kercheville told KXAN. “Fast forward, and I ended up making a list of 40 people, all of whom had identical charges.”

“It is a huge cash cow,” he said. “It could be thousands of claims … It is not chump change. We are talking about potentially huge, huge numbers.”

Nationwide, the problem is costing taxpayers big.

Medicare processes over a billion claims per year, according its annual report. One expert told KXAN that fraud, error and abuse cost taxpayers $60 billion a year, and billing problems associated with durable medical supplies – like diabetic monitoring equipment – are on the rise.

Medicare fraud and abuse lead to higher healthcare costs and taxes for everyone, according to CMS.

Valerie Bennett received a Medicare statement in September for diabetic supplies she never needed or was prescribed. (KXAN Photo: Chris Nelson)
Valerie Bennett received a Medicare statement in September for diabetic supplies she never needed or was prescribed. (KXAN Photo/Chris Nelson)

Multiple complaints

Leslie McKinney, of Buda, received a Medicare bill in October for diabetic supplies she never needed or ordered. McKinney’s bills originated from a company located 150 miles away in Tomball. McKinney also uses Nextdoor and noticed several people living near her received identical improper bills.

The charges impacted both McKinney’s Medicare account and supplemental insurance, and she filed complaints with both. Then she was hit with a second round of improper charges a month later, she said. Her supplemental insurance denied the charges, but Medicare paid the claim despite McKinney’s previous complaint.

“Medicare could at least put a hold, when fraud is suspected. They could at least put a hold on a company until an investigation is complete instead of paying out Medicare dollars,” she said.

Bob Segurson, of Round Rock, found himself in a similar situation. He discovered a $711 charge on his Medicare summary in October for a diabetic glucose monitor he never ordered or received from a Tomball medical supplier. He filed a complaint and then received a charge again the next month.

“It’s upsetting that it’s happening, and people seem to be getting away with it,” Segurson said. “It hits both Medicare and the extra insurance companies.”

Segurson said his secondary insurance coverage picked up part of the erroneous billing, and those premiums are increasing over 12% next year.

KXAN has asked CMS for comments on the expanding number of Medicare complaints and why the agency appeared to continue paying claims to a business after receiving complaints about the same charges.

A CMS spokesperson previously said the federal agency “would not comment on complaints and rarely comments on specific cases.”

Resources: what to do about questionable charges

KXAN also asked CMS how they notify supplemental insurance companies of potential Medicare fraud and scams. We will update this story when more information from CMS becomes available.

CMS recommendations:

  • 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.

Who’s behind it?

It isn’t clear who could be behind the improper billing.

KXAN reached a representative of the former owner of the San Antonio medical supply business. The representative said the former ownership had nothing to do with the billing problems and sold the operation in May prior to the Medicare claim issues. The representative also provided paperwork to prove the sale and wire transfer. KXAN could not reach the new owners.

A representative of the business in Hutchins told KXAN by phone they sold the company but would not comment further. KXAN could not reach the owners of the medical supply business in Tomball.

Though the billing problems appear tied to specific establishments, that doesn’t mean those entities are involved.

Jennifer Salazar, Executive Director of Texas Senior Medicare Patrol, said fraudsters “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.”

The Better Business Bureau of Houston uses federal grants to fund Texas Senior Medicare Patrol, which helps people report Medicare billing problems by gathering complaint information and providing it to the correct authorities. Questions can be directed to Texas Senior Medicare Patrol’s hotline at 1-888-341-6187.

Salazar advised all Medicare recipients to check their explanations of benefits and billing summaries for questionable claims.

CMS also provided resources for spotting and reporting Medicare billing problems: