Medicare fraud


  #1  
Old 04-19-16, 02:55 PM
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Medicare fraud

As most of the regulars know I had quite a time with my health last year. Among the various problems was one doctor that insisted I go on a CPAP before he would allow me to have my kidney stone removed under general anesthesia.

Anyway, I called the company that had supplied the CPAP machine to find out when they were going to stop billing me for its rental. The agent that supplied it told me that my private insurance at the time would pay the entire cost (less my deductible) and that after four months the machine would be mine. When I called I was told that the machine I had was NOT on a purchase contract but a month-by-month rental. I asked if that meant I could return the silly thing and was told yes.

To properly set the stage, I was issued this CPAP last January (2015) and used it pretty regularly until I had the operation. Afterwards I used it intermittently but never thinking it was all that much help. In June (2015) I lost my private insurance and went on Medicare. I procrastinated until August at which time I called as referenced above. This call was made on a Friday and I returned the machine the following Monday or Tuesday to their store. While there I asked to be given a final billing but the receiving clerk stated the home office would send me a bill. I also gave her my Medicare card, which she copied, in case Medicare would pick up the tab for the months I didn't have private insurance coverage.

Well, they sent me a final billing but made no mention of any Medicare payment or rejection. I sat on it until the end of November when I sent them a letter stating that I had received no statement from Medicare, either a payment or rejection notice and therefore assumed they had not yet billed Medicare. I asked why and added my Medicare insurance card information. Then I did something extremely stupid, I sent them a check for the full amount and asked to be reimbursed the amount Medicare did pay. I never received any response to this letter.

However, I DID receive a notice from Medicare dated December 24 in which they stated they paid the company and the maximum I could be billed was $10.49. Not wanting to make a fool out of myself for transit time in the mails I waited until January (this year) 25 and sent them another letter asking where was my refund? I never received any response to this letter either.

Finally, I called their local office on April first and requested to speak to someone in billing with enough "horsepower" to resolve this matter. The woman I spoke with looked up my account and found no letters. I told her what had taken place over the months and she said she would have to verify the information and then get back to me. It is now over two weeks and still no call, letter or refund. The amount is not trivial, being in excess of $200.00.

As I see it I have four options: 1) Chalk it up to experience and never, ever make a final payment on a disputed billing. 2) Turn it over to my lawyer, which will cost me money to pursue. 3) Turn it over to the Consumer Affairs reporter at one of the local television stations. 4) Report it to Medicare as a case of fraud. I've looked into the last and it seems to be rather intensive on my part, something I don't particularly want to do, but darn it, the company has for all intents and purposes stolen either my money or Medicare funds.

Any suggestions?
 
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Old 04-19-16, 04:50 PM
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Well I sure as heck wouldn't chalk it up to experience and let it go! First, I'd keep calling this company and ask to talk to a supervisor or manager.
The TV stations can be helpful, if you can get them to help.
If you're on a fixed income, you'd probably qualify for legal aid. Usually all they need to do is write a letter to the company to get things moving in your favor.
If none of the other things work (which I'm sure they will if you don't give up) I'd then report it as fraud.
 
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Old 04-19-16, 08:38 PM
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Joel I am sorry you are having so many problems this just isn't fair with all of your previous problems too. I wouldn't be surprised that this company may already be having lawsuits filed against it and a search by any search engine may unearth a class action lawsuit so you may not need to hire your own lawyer. Also consider contacting your local states attorney office as they may want to get involved in getting you your money back. I also would contact Medicare but they can be very slow and the outcome may not always be in your favor even though it should, it happened to us so beware.
 
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Old 04-20-16, 03:16 AM
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Sad to say, paying the bill was like throwing money down a well. You'll never see it again. I have waited on Medicare statements for months, but they finally show up with their payment to the provider. The provider sends statements, too, but I don't bother with them until I get the Medicare/supplemental statements. Public shaming via the media may help, who knows.
 
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Old 04-20-16, 03:18 AM
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Not sure if you just have medicare or one of the advantage plans. I have the latter and their customer service has been very helpful in the past when a doctor's office was routinely over billing me. As mentioned above I wouldn't let it go, hound them until something happens! The advertising line 'it's my money and I want it now' comes to mind
 
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Old 04-20-16, 07:35 AM
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Thank you for the comments.

Shadeladie, I am on a "fixed" income but between my pension and Social Security I am well over any maximum income limits for reduced prices on anything.

Richard, doing a Google on the company name mostly returns info on a drug with the same name. Only one legitimate hit and that is for the company itself which states it is the largest supplier in the pacific northwest. Contacting the Attorney General is probably a good idea.

Larry, I got the Medicare statement less than a month after sending in the full payment and also including my Medicare info. I suspect that the company never billed Medicare when I returned the machine. I somewhat remember reading that Medicare only sends out statements quarterly and this is one reason why they urge people to have an on-line account with Medicare...so you can see the statements sooner.

Mark, I do have an Advantage plan, now. At the time of services however all I had was straight Medicare.


The company doesn't seem to be afraid of my notifying Medicare. Maybe they know Medicare is slow and at worst all they will find is some lost bookkeeping for a single customer. Maybe I am naive and too trustworthy but I prefer to think that it IS a simple bookkeeping error and all I need to do is find the right person to fix it. I've thought about going to their Seattle store and making a scene (I'm pretty good at that) but parking in the area is a real problem and I can't walk all that far these days. I am going to follow Shadeladie's suggestion and call them today, get the senior manager on the phone (if possible) and ask them just what is the problem. I have copies of the letters I wrote as well as the Medicare statement and my check so proving that both I and Medicare paid should not be a problem.
 
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Old 04-20-16, 01:30 PM
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You may be right, in that Medicare sends sporadic statements. I have it all online with notifications sent via email. I usually check things quickly after I go see a doctor to make sure things are being taken care of. I don't get paper statements any more.

I find the direct route is always best. Wifey had a serious accident that messed up her jawbone and associated teeth. Every time, BCBS would deny the claim since we didn't have dental coverage. It was an accident, not routine dental work, for crying out loud. I finally took one of the denials to the BCBS regional office and asked who was in charge. I saw the name on a door and went right in and sat on her desk, explaining the situation for a final time. Of course no one could stop me due to my size. I think she understood.
 
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Old 04-20-16, 01:35 PM
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Option 5: file a case in small claims court. That's the only way to talk to someone with enough "horsepower". You're guaranteed to get a call & when they call, tell them that you'll see them in court.

Option 6: If the phone # ends in let's say 2400, you dial 2401, then 2402 & so on. Eventually, you'll find a big shot.

Option 7: Give me the name of the lady with the "horsepower" & I'll get her home phone #. Then call her around midnight. I guess you won't like that option. I thought that I would mention anyway.
 
 

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