INDIANAPOLIS— Ann Midkiff of Indianapolis takes her retirement seriously. But she admits she hasn’t always taken her Medicare statements seriously.
“Do I look at them all the time? Not always,” said Midkiff.
But a recent Medicare statement caught her eye— more than $3,000 worth of urinary catheters billed to Medicare using her Medicare number.
Midkiff said she never used or ordered any catheters.
“At first I thought, it must be a mistake on my account,” said Midkiff. “I was concerned about fraud.”
The same thing happened to Medicare member Nancy Moore.
"They billed for two months, so around $3,000 Medicare paid and also my supplement paid,” said Moore. “I didn’t give out my Medicare number. I don’t know how they got it.”
WRTV Investigates is tracking a big uptick in fraudulent billing—sometimes called phantom billing— to Medicare for urinary catheters.
It’s a problem that is currently costing taxpayers millions and has the potential to increase premiums for Medicare members in the future.
Nancy Moore is also the director of Indiana Senior Medicare Patrol, a grant-funded project of the U.S. Department of Health and Human Services aimed at preventing healthcare fraud.
“It’s like phantom billing,” said Moore. “Everything looks good on paper. We are getting dozens of complaints.”
WRTV Investigates called the Brooklyn, NY supplier listed on Midkiff’s Medicare statement and we got its voicemail.
WRTV Investigates left a message and we are still waiting to hear back.
We all are paying for it whether you're working or not or on Medicare or not,” said Moore.
In fact, a new report from the National Association of Accountable Care Organizations and the Institute for Accountable Care just released a report showing just how much the problem is costing taxpayers.
They’re an advocacy group that represents hundreds of health care systems across the country.
Medicare payments for catheters increased from $153 million in 2021 to $2.1 billion in 2023, according to an analysis of Medicare claims data the provided to researchers.
The analysis also found more than 40,000 patients were billed for catheters in 2021, a number that ballooned to more than 450,000 last year.
“We felt it was important to stop this activity and went to the media to raise the profile of it,” said Clif Gaus, president and CEO of the National Association of ACOs. “We’re pleased to see to see the level of attention it has received, which speaks to the importance of the issue and the work ACOs do to be good stewards of the Medicare program.”
Almost all of the increase was due to billings by the seven identified durable medical equipment (DME) suppliers that did not exist even two years ago, according to the analysis.
All kinds of fraud, mistakes and abuse cost Medicare an estimated $60 billion each year, according to the Federal Trade Commission.
Last year, WRTV Investigates uncovered a similar problem involving charges for unwanted COVID-19 tests.
PREVIOUS | Feds warn to check statements after unwanted COVID tests billed to Medicare
WRTV Investigates reached out to the Centers for Medicare and Medicaid Services (CMS) to find out what the federal government is doing to address this problem.
"CMS does not confirm or discuss the existence of any ongoing investigation to ensure we do not compromise the integrity of the investigative process,” a CMS spokesperson said in a statement to WRTV. “However, that does not mean actions are not being taken behind the scenes."
If you receive items you did not order or your Medicare Summary Notice lists products you didn’t authorize, you should call 1-800-MEDICARE (1-800-633-4227) to report the situation.
Nancy Moore and Ann Midkiff both called Medicare and received new Medicare numbers and cards.
Midkiff is worried it will happen again and recommends every Medicare number be vigilant.
“Look at your statements every month,” said Midkiff. “Go over them completely and be sure that everything listed is something you actually used. "
You can report fraudulent or phantom billing to Senior Medicare Patrol at 1-800-986-3505.
WRTV Investigates reached out to Indiana members of Congress to find out what they're doing about phantom billing.
"What I've done is initiated a letter along with another Senator to ask the General Accounting Office to look into it," said U.S. Senator Mike Braun. "They're going to. They've scheduled an audit, so we will at least that to report back on."
Braun also introduced legislation, the Medicare Transaction Fraud Prevention Act, which directs CMS to create a two-year pilot to oversee Medicare-covered purchasing of medical equipment and other diagnostic testing related products.
"It’s changing the process and procedures to make it more accountable," said Braun.
Braun is working to gather support for the legislation.
WRTV Investigates also asked CMS for data on how often these fraudulent catheter charges are happening, and we did not receive that information.
FULL STATEMENT FROM CMS
“CMS is committed to preventing fraud and protecting people with Medicare from falling victim to fraud. We can take swift actions to prevent illegitimate payments from going to bad actors when we have credible allegations of fraud. CMS does not confirm or discuss the existence of any ongoing investigation to ensure we do not compromise the integrity of the investigative process. However, that does not mean actions are not being taken behind the scenes.
If a person with Medicare receives items or services they did not order or authorize, or if they notice their Medicare Summary Notice includes items or services they did not order or receive, they should immediately contact 1-800-MEDICARE (1-800-633-4227) to report the situation. People with Medicare coverage can request a new Medicare number if they suspect their current one has been compromised. Additionally, anyone can report suspected Medicare fraud by contacting the HHS fraud hotline at 800-447-8477 (which is 800-HHS-Tips). People with Medicare can also call their local Senior Medicare Patrol (SMP). To find the SMP in their state, they can go to the SMP Locator or call the nationwide toll-free number 877-808-2468 and ask for the SMP phone number in their state.
It is important to note that beneficiaries have no financial responsibility for paying for fraudulent claims. CMS closely monitors provider billing behaviors and reviews every complaint to determine if further action is necessary. Depending on the circumstances, this may include (but is not limited to) beneficiary and provider/supplier interviews and medical record reviews. Billing analytics and beneficiary calls allow CMS to proactively identify and investigate potential vulnerabilities associated with program integrity issues.
Furthermore, CMS works closely with the HHS Office of Inspector General and the Department of Justice to investigate health care fraud schemes, referring cases to law enforcement partners as appropriate. If CMS determines an overpayment was made, the agency recovers those funds. CMS also has authority to take other administrative actions, such as revoking a provider’s ability to participate Medicare programs, as well as make referrals to law enforcement to pursue criminal and civil charges.
It is important to note that any potential fraud figures mentioned may not be accurate. When any supplier of catheters or orthotic braces or any other type of durable medical equipment submits a claim to Medicare for payment, it goes through our system to ensure that it is eligible for payment. Once that process is complete, CMS also checks to ensure that the provider or supplier is not on a suspension list. If a provider or supplier is on a suspension list, then CMS will prevent the payment. This means that even though a claim may publicly show up as paid, the money doesn’t go out the door.
CMS implements several program integrity efforts and applies advanced data analytics to detect and prevent fraudulent activities. We also take swift action to address suspected fraud, including preventing payments from being made and revocation action to prevent suppliers from billing for dates of services on or after the revocation effective date. When needed, we also update and develop regulations to prevent future abusive billing.”
Consumers can also report suspected medical identity theft to the Health & Human Services fraud hotline: 800-447-8477 (800-HHS-TIPS) or the National Insurance Crime Bureau at 800-835-6422.
