OIG’s Most Wanted … For Medicare fraud

1. OIG’s Most Wanted … For Medicare fraud

2. Have You Seen This Man?

3. 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)

4. Both centers purported to provide medical services, including rare outpatient HIV infusion and cancer drug therapies • According to the indictment, Velazquez submitted false Medicare Enrollment Applications in order to fraudulently receive claim payments for services allegedly provided by Florida physicians • Additionally, Velazquez allegedly used the identifying information of Medicare beneficiaries to submit claims for services that were never provided • Velazquez is currently at large

5. How About this Woman?

6. OIG Fugitive Susan Bendigo • In February 2009, Susan Bendigo (aka Susan Lim) was accused in a Federal indictment of billing Medi-Cal, California's Medicaid program, for $17.1 million in fraudulent claims • Approximately $10 million was paid to Bendigo and others, half of which came from the claims she submitted for services that were allegedly provided by unlicensed staff

7. Bendigo was a registered nurse and Director of Nursing for MedCare Plus Home Health Provider, operating in Santa Fe Springs, California • MedCare purportedly provided nurses for home health agencies • Investigators believe that, from May 2004 through May 2007, Bendigo sent unlicensed nurses to treat patients under Medi-Cal, even though she knew that Medi-Cal required licensed nurses to perform the work • Bendigo remains at large. Authorities believe she may be residing in the Philippines

8. These Are Just Two of the Over 170 Fugitives on the OIG’s Most Wanted Listhttp://oig.hhs.gov/fraud/fugitives/index.asp

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

10. 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

11. PROTECT DETECT REPORT

12. Your Medicare Card is Your Healthcare Credit Card =

13. 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

14. 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

15. Common Health Care Fraud Schemes • Medical clinics, patient recruiting • Upcoding Ambulance trips • Laboratories, billing unnecessary procedures • Doctors, toenail trimming billed as a surgical procedure • Home Health Agencies, services for patients who are not homebound

16. Stolen Medicare Numbers - Used by fictitious health care providers - Patients usually unaware “Capper” schemes - Solicitation at senior housing facilities Medical Equipment - 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

17. 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

18. How Can You Report Fraud? • Simply call the SMP Hot Line at (855) 613-7080 • Or 1(800) MEDICARE (633-4227) • We may need • Description of the situation • Name of provider involved • Name(s) of Beneficiary involved • Supporting Documentation • Medicare Summary Notices, etc.

19. It Would Really Help us if You would - Focus on fraud

20. Outreach, Education, 1/1 Counseling Peerplace CHECK the BOX

21. Outreach / Education Activities • 1/1 & Telephone Counseling • Disseminating SMP materials • Better educated beneficiaries • More aware community • More calls to the Fraud Hotline • Decline in Medicare fraud • Less $s lost to fraud

22. When You Mention Fraud…. • In your Medicare presentations… • CHECK THE BOX • When you counsel someone in person or on the phone… • CHECK THE BOX • When you give someone a brochure at a health fair… • CHECK THE BOX

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