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Hawaii taxpayers lose close to $208,500 a day to Medicare fraud, waste and abuse. As baby boomers become beneficiaries, state officials fear that figure may rise. Volunteers arm seniors
to fight Medicare abuseBy Janine Tully
Star-BulletinThe state loses about $73 million a year, according to the U.S. General Accounting Office.
To stem Medicare/Medicaid fraud, the state Executive Office on Aging has established SageWatch, an outreach program that educates seniors on how to become better health consumers, as well as watch for possible errors on their medical bills, prescription refills and health services.
Made up of volunteers, SageWatch takes its message to retirement homes, day-care centers, clubs and wherever seniors gather.
Recently, about 30 people delayed their weekly morning bingo game at Lani Huli senior housing in Kailua to listen to SageWatch volunteers tell them how to avoid falling prey to unscrupulous health vendors.
"Whatever you do, don't give anyone your Medicare card number," warned SageWatch coordinator Deborah Hanson. "It can be used as a credit card."
Hanson referred to an incident in California where an orthopedic doctor was offering free running shoes to patients who would undergo various tests at his clinic. The patients would come out with expensive running shoes, but the doctor was billing Medicare for $3,500 orthopedic shoes, Hanson said.
"He wasn't stealing from the patient, but he was stealing from Medicare."
Hanson also cautioned seniors to be careful about free services offered at health fairs.
"You might get a free cholesterol or blood-pressure test, but they might bill Medicare for all sorts of extraneous tests," she said.
While it is estimated that only 2 percent of people commit medical fraud, the amount of money being lost to it is great -- close to $24 billion a year nationwide, according to the federal government.
Last month the state settled a $4 million fraud case against Interstate Pharmacy Corp., a supplier of drugs to long-term facilities here, for illegal pharmacy and billing practices. In 1992, Longs Drug Stores paid the state $2.3 million for filling in Medicaid prescriptions with brand-name drugs when generic drugs are required by state and federal law. And in 1997 a Hilo obstetrician was indicted for billing Medicaid for patients he didn't treat.
"We don't want to give the impression that we are vigilantes trying to get doctors," said Hanson. "We are asking people to be alert. That's how fraud is stopped."
Among tips that appear in a SageWatch handout are:
Hanson particularly emphasizes reviewing Medicare statements, which have a lot of numbers, dates and codes, and which can be confusing.Keep a record of all your doctor visits and hospital stays.
"Make sure your name is on it and that the services that are there are services you actually received," she said.
Also, count the number of pills in a bottle.
"Sometimes pharmacies make mistakes and don't give you the right amount," Hanson said.
A senior, who didn't want to be named, said a local pharmacy never told her she could get generic pills. It also didn't include the medical literature that normally comes in the box, and she had side effects from the pills.
"I'll never go back to that pharmacy," she said.
The presentation also includes an explanation of Medicare and Medicaid. Medicare is a federal program available to anyone 65 or older or disabled and who has paid into the system through their job. Medicaid is a state program open to everyone but is based on income level, not age.
In its third year of operation, SageWatch gives six to seven presentations a month and there's a waiting list of senior groups who want to hear the talks. Presentations are given on Oahu, Maui and Kona, and Hanson hopes Kauai and Hilo will be next.
"We have more requests than volunteers," Hanson said, noting that the program has 33 volunteers statewide, mostly retired professionals. "Our volunteers are the backbone of our program."