ISN’T THIS FRAUD?

For years, I have helped to protect the senior citizen clients of this insurance agency from financial harm due to mistakes in the Medicare system. People make mistakes. I just investigate the medical bill problems of our clients and expose the mistakes that others make and ask them to correct those mistakes. By doing this, I have saved our clients over one million dollars.

But, in the last full week of June 2015, I noticed a pattern with one significant medical service provider in northwest Indiana and the medical billing firm in Indianapolis that it used. It did not seem like a “mistake” pattern but a “fraud” pattern. Here are some details.

In the same week, two of our senior citizen clients forwarded medical bills to me to review for them. One client was from Griffith and the other client was from East Chicago in Indiana. In each case, the recent bill had been paid months ago by the client’s Medicare supplement insurance company. The dates pattern between the bill and the prior payment was too far apart to consider it just a case of a crossing of payment and bill in the mail. It was a definite pattern of an insurance company paying the senior citizen’s medical bill, but the payment not being credited and the senior being billed despite the prior payment. Isn’t this fraud?

On average, these bills were about $100. If a medical billing service company is collecting money from insurance companies but not crediting the senior citizens’ bills properly and accurately, then the senior citizens are being robbed, right? The seniors are being tricked into paying medical bills that were already paid by their insurance companies. This seemed to me like a very clever way of siphoning money from insurance companies and seniors. If other seniors are just paying the bills without questioning them, then many seniors are paying bills that they don’t owe. Without the help of someone like me who knows how to investigate seniors’ medical bills, the bookkeeping trick would not be found because both the insurance company and the senior paid a bill and neither knew that the bill was paid by the other. It could be a scam that collects millions of dollars per year wrongfully.

I could not determine if the bad bookkeeping of the accounts was the fault of the medical service provider or the medical billing firm. So, in my letter to the billing service and the medical service provider, I citied the fact that the bill had been paid months before the bill was sent to the client. I cited the check or transaction numbers of the payments and the dates of the payments. Then, I finished the letter with the following paragraph.

“Finally, if your billing service failed to keep accurate records on this account, how many other accounts were misreported as this one was? Also, if your firm did not get the money that was paid on patient accounts by insurance companies, who got that money?”

Note: Woodrow Wilcox is the senior medical bill case worker at Senior Care Insurance Services in Merrillville, Indiana. He has saved clients of that firm over one million dollars by correcting errors and mistakes in the Medicare system. He wrote the book SOLVING MEDICARE PROBLEM$ (www.solvingmedicareproblems.com).

© 2015 Woodrow Wilcox

www.WoodrowWilcox.com