OIG’s Most Wanted … For Medicare fraud OIG’s Most Wanted … For Medicare fraud 1

Have You Seen This Man? 2

OIG Fugitive Luciano Velazquez In February 2010, indicted on charges of – Health Care Fraud – False Statements Related to Health Care Fraud Matters – Aggravated Identity Theft Billed Medicare more than $8 million in false claims; collected $2.9 million Owned and operated Luciano Medical Center and S & A Rehabilitation Center (SARC) 3

Purported to provide medical services, HIV infusion and cancer drug therapies Velazquez submitted false Medicare Enrollment Applications to receive claim payments for services allegedly provided by Florida physicians Used Medicare beneficiaries’ IDs to submit claims for services that were never provided Velazquez is currently at large 4

How About this Woman? 5

OIG Fugitive Susan Bendigo In February 2009, Susan Bendigo (aka Susan Lim) accused of billing Medi-Cal for $17.1 million in fraudulent claims Approximately $10 million paid to Bendigo and others, including claims submitted for services allegedly provided by unlicensed staff 6

Bendigo - registered nurse, Director of Nursing for MedCare Plus Home Health Provider, in Santa Fe Springs, California MedCare purportedly provided nurses for home health agencies Investigators believe that Bendigo sent unlicensed nurses to treat patients under Medi- Cal Bendigo remains at large Authorities believe she may be residing in the Philippines 7

These Are Just Two of the Over 170 Fugitives on the OIG’s Most Wanted List 8

Why Should You Care? You Could Be their Next Victim … 9

Or it could be her! This is not just about preserving Medicare dollars, but preserving Medicare for her and all of the millions of beneficiaries who depend on Medicare 10

REPORT PROTECT DETECT 11

Your Medicare Card is Your Healthcare Credit Card = 12

An Ounce of Prevention Prevention really is the best medicine Consumers can make a big difference by: – Knowing what their health care covers – Not giving out their Medicare number to strangers – Creating a good relationship with their doctor – Review (and save) letters, bills and insurance statements (“this is Not a Bill”) – Report unusual activities 13

Read your msn as you would your credit card statement Your Medicare Summary Notice is a statement of what Medicare paid to providers who billed your Medicare Number Read it carefully 14

Common Health Care Fraud Schemes “Capper” schemes - Solicitation at senior housing, food banks, malls, etc. Up-coding ambulance trips Laboratories billing unnecessary procedures Doctors billing toenail trimming as surgical procedure Home Health Agencies providing services for patients who are not homebound 15

Stolen Medicare Numbers - Used by fictitious health care providers - Patients usually unaware Durable Medical Equipment Providers - Bill extraordinary number of claims using stolen Medicare numbers for items never received - Diabetic Supplies - Wheelchairs and Scooters Health Care reform bill - Callers saying they are from Medicare, stating Medicare has changed and needs their personal information Types of Fraud in California 16

Beware of providers who … Advertise “free” services, but request Medicare number from patients Want to verify a senior’s Medicare/Medi-Cal status Say they know how to get Medicare to pay for something Use high pressure sales or scare tactics Use telemarketing or go door to door to sell something Have patient ask their doctor for services or supplies that aren’t needed 17

ACTUAL CASE SCENARIOS 18

$15 million Dollar Medicare Fraud Medicare patients at board and care homes throughout Southern California were given unnecessary respiratory tests Some owners of the board & care homes received kickbacks Doctors sometimes gave patients soda, candy and cigarettes. Many treatments given in the smoking rooms at facilities Seniors reported unnecessary tests to the Long Term Care Ombudsman 17 providers prosecuted for kickbacks and healthcare fraud. Sentenced to prison; have to pay restitution. 19

Help! Get this bed out of my house!! Beneficiary called Medicare; referred to SMP DME provider delivered hospital bed in very poor condition Hospital bed did not fit the beneficiary Beneficiary has called the DME provider multiple times The DME provider continues to give beneficiary the runaround In the meantime, Medicare has paid 3 months of bed rentals to the DME provider Mike Ito, SMP Liaison, worked with beneficiary Case referred for investigation SMP called DME supplier; bed finally picked up 20

But… I Didn’t Ask for This Equipment! Service Coordinator at Senior Housing called SMP DME supplier continues to deliver unwanted, unsolicited diabetic supplies to beneficiary Beneficiary is non-English speaking SMP confirmed that Medicare has paid DME for several months’ worth of supplies Advised Service Coordinator to call DME supplier; cease and desist (to no avail) Case referred for investigation 21

Beneficiary Stuck Between a Rock and a Hard Place Beneficiary received Scooter chair July 2011 Immediately called to have it returned Now all she wants is to have her old wheelchair repaired Repair service says they can’t repair it for fear they won’t get paid since Medicare shows new chair still on beneficiary’s record SMP pursued w/ Medicare and repair service Beneficiary will finally get old chair repaired 22

No Such Thing As a Free Lunch Beneficiary attended presentation at Senior Center Provider advertised FREE Balancing Testing Beneficiary made appt. Beneficiary had ear wax removed (5 minutes) Provider charged $300 for new patient visit and $100 for ear wax removal Medicare paid for both Case referred to Zone Integrity Unit 23

Please stop calling me! Durable medical equipment companies Call beneficiaries very early in the a.m. Use high pressure tactics Promise free supplies Phone scammers Use the Affordable Care Act to offer a more secure Medicare card Try to obtain Medicare #s and/or banking information 24

On the Internet, no one knows you are a dog 25 Medicare fraud can be perpetrated on the Internet also Be very aware of suspicious s Do not respond to s sent from persons you don’t know Do not order medical equipment from a supplier who sends you unsolicited Some real-life examples: “Find senior living that fits your needs!” “Free glucose meter, diabetes testing supplies & shipping” “Medicare Open Enrollment: Better care, Lower rates: Find a Plan”

How Can You Report Fraud? Simply call the SMP Hot Line at (855) Or 1(800) MEDICARE ( ) Or call HICAP 1( ) We may need – Description of the situation – Name of provider involved – Name(s) of Beneficiary involved – Supporting Documentation Medicare Summary Notices, etc. 26

Thank you for all You Do to fight fraud, help beneficiaries and protect medicare! 27