On May 19, 2016, the doctor who chairs a department at a hospital phoned me and apologized with an explanation that sparked my suspicion.
The doctor explained that ever since the medical billing firm that it used was bought by a conglomerate corporation, the medical billing firm has repeatedly bungled bills to patients and their insurance companies.
The doctor phoned me because about a dozen of our clients have received bills from the billing firm despite the fact that their insurance company had paid all the balances on all the clients’ bills. I have helped five of our clients file complaints with the Indiana Attorney General Consumer Protection Division. In each case, the Attorney General has sided with us. I wrote to the president and chief executive officer of the insurance company that has done the most paying of bills which were not credited to our clients’ accounts by the medical billing firm. I have worked, lived, and breathed by our insurance agency’s commitment to protect our clients from financial harm when someone else in the Medicare system commits fraud or a mistake.
I believe that the tide is turning in our clients’ favor. But, for many seniors who don’t use an insurance agent or agency that will help to protect them, the result is that THEY PAY MEDICAL BILLS WHICH WERE ALREADY PAID BY THEIR INSURANCE COMPANY.
Here is what I suspect because of the doctor’s phone call to me. I suspect that a large corporation could buy a good billing firm and turn it into a Medicare fraud machine. By putting new computer managers over the old ones or simply replacing the managers of the bought firm, the computers could be reprogrammed. How difficult would it be for an international corporation to redirect the electronic payments of insurance companies to a bank account of a related corporation in a foreign country? In such a case, both the patients and their insurance companies would be easily robbed thousands of times on a daily basis.
Recently, another doctor informed me that on October 15, 2015, new rules from the Obama administration forced doctors in the Medicare system to take payments electronically. That means electronic funds transfers (EFT). Electronic funds transfers are the way that our clients’ insurance company has sent payments on their bills, but the medical billing firm claimed that it never received the funds.
Medicare officials admit that there is fraud in the Medicare system. But, either they don’t know where to look, or they don’t want to look where they might find some sneaky and politically connected parties committing the fraud. I’d really like to tell Medicare officials and Congress a few places where I think the search for fraud should begin.
Note: Woodrow Wilcox is the senior medical bill case worker at Senior Care Insurance Services in Merrillville, Indiana. He has helped clients of that insurance agency save over one million dollars by fighting mistakes and fraud in the Medicare system. He wrote the book SOLVING MEDICARE PROBLEM$.
© 2016 Woodrow Wilcox