FREE SEMINAR AIMS TO HELP RESIDENTS AVOID FRAUD

Trying to decipher the codes and jargon on his mother's pharmacy bill, Cape Girardeau Police Capt. Steve Strong was struck with how easy it would be for an unscrupulous provider to defraud the system for great sums of money.

"One item was $50 and if you falsely billed each of 30 people for an extra $50 per month, they would add up pretty fast," said Strong, a member of the TRIAD/SALT Council, which is co-sponsoring a March 27 seminar on Medicare fraud at Grace United Methodist Church.

In fact, such fraud happens all the time. Last year, the Medicare program lost more than $20 billion to fraud, waste and abuse, according to American Association of Retired Persons.

The free seminar, titled "Medicare Fraud: Who Pays? You Pay," is designed to help alert area residents to this problem. Speakers from the Missouri Attorney General's Office, district attorney's office, Federal Bureau of Investigation, AARP, APPLE Project and the Division of Aging will speak on identifying and reporting questionable Medicare charges and offer prevention tips on avoiding becoming a victim of fraud.

The TRIAD/SALT Council is a coalition of senior citizens groups and law enforcement,

Fraud is a really big problem, said Wally Richter, AARP state coordinator for consumer issues. Problems range from simple mistakes on medical bills to overcharges to charging for services or equipment never received.

"Many people, especially older people, think of doctors as gods and hospitals as infallible," said Grace Hoover, a member of the TRIAD/SALT Council, "They never question or review their medical bills; they just pay them."

Yet scrutinizing bills and asking questions about charges is the best way to fight fraud, said Dr. William Bourns, a member of the TRIAD/SALT Council, a coalition of senior citizens groups and law enforcement, and an assistant professor in the criminal justice department at Southeast Missouri State University.

"At the grocery store, people carefully check to make sure they aren't being overcharged for items," Richter said. "But because Medicare or an insurance company is paying a medical bill, these same people don't even bother to look over the bill."

But when Medicare or insurance companies are cheated, it hits everyone in the pocketbook because we pay for fraud through higher taxes or premiums, he said.

"Everyone who gets a bill should check carefully to see if they got what is listed," Richter said.

Things to look for include:

* Charging more than once for the same service (double billing).

* Charging for services never performed or medical equipment/supplies never ordered.

* Performing inappropriate or unnecessary services.

* Offering free services or medical equipment in exchange for your Medicare, Medicaid or private insurance number.

* Providing lower cost or used equipment while billing Medicare, Medicaid or an insurance company for higher cost or new equipment.

* A supplier completing a certificate of medical necessity form for a physician.

If a discrepancy or questionable charge is found on a bill, Richter said to first call the medical provider and ask about it.

"Most providers are honest and you need to give them a chance to explain the charge of correct the problem if a mistake is made," Richter said.

If the provider doesn't have a satisfactory answer and abuse or fraud is suspected, Richter said there is a Medicare Fraud Hotline, (800) 447-8477 or people can all the state attorney general's office or a U.S. attorney's office.

"Fraud can be reduced if those considering defrauding Medicare know they are being watched and could be caught," Richter said.

IF YOU GO

"Medicare Fraud: Who Pays? You Pay"

What: A seminar on preventing Medicare fraud sponsored by the TRIAD/SALT Council, AARP, Cape Girardeau County and Southeast Missouri State University Institute of Gerontology

When: March 27, with registration at 8 a.m., program at 9 a.m. and a complimentary lunch at 12:30 p.m.

Where: Grace United Methodist Church, Broadway and Caruthers

How much: Free. To register for lunch, call 651-5194.

Tips to Avoid Fraud

Avoid becoming an unknowing victim

* Review all statements from medical service providers. If you find questionable charges, contact your provider or the Medicare or insurance company listed on the front of your Medicare statement. If you continue to have questions, call the Medicare Fraud Hotline at (800) 447-8477.

* Treat your Medicare card like a credit card. Never give out your Medicare number over the phone unless you initiated the call. If your card is lost or stolen, report it immediately.

* Don't accept free medical equipment or services in exchange for your Medicare number -- nothing is ever free. Unscrupulous providers could bill Medicare for services or equipment you may have never received.

* Stay informed. Know what services or equipment you are supposed to receive so you can avoid getting something you don't need.

* Be alert to those who claim to "know how to bill Medicare" to get an uncovered item or service paid for -- it's a scam. Report it immediately.