Medicare ID Theft Growing as Quickly as Boomer Elders

Digital medical records have become the favorite fraud outlets for ID theft hackers. Published reports from late last year stated that approximately $47 billion were stolen from questionable Medicare payments.

The Medicare system has become the "single biggest victim" of health care fraud in America, according to Rob Montemorra, chief of the FBI's Health Care Fraud Unit.

The payoff for health care identity fraud is mind boggling. In 2008, criminals pocketed more than $19,000 per incident of health care fraud, which is more than three times the amount gained through overall ID theft, according to Javelin. The cost to the individual victim was nearly $1,200, more than double that of overall ID theft.

Health care identity theft has outgrown all other crimes in the field last year, according to Louis Saccoccio, executive director of the National Health Care Anti-Fraud Association (NHCAA).

"Since we all pay taxes, we are all our victims because the cost of this [crime] is coming out of our pockets," according to Montemorra.

Continue to encourage your clients to review their Medicare receipts and be cautious about who they share their medical health and billing information with. Promoting awareness and support about this issue will help strengthen relationships and prevent Medicare ID theft in your community.

Additionally, when Medicare fraud becomes rampant, it’s an easy decision for legislatures to tighten the belts on the Medicare system. It saves the system some money, and looks great on election day. Unfortunately, it means that the true savings are often negligible, yet the additional expense and increased scrutiny for good quality Medicare providers is a hardship.

Source: CNN

“Avoidable” and “Unavoidable” Pressure Sores

The development of pressure sores on a client can easily go unnoticed to the untrained eye. They can cause serious infections, some of which can be lethal. Pressure sores are a major concern for any home care company.

The Center for Medicare & Medicaid Services (CMS) categorizes pressure sores under both “Avoidable” and “Unavoidable”. These definitions serve as a map for potential malpractice situations, and need to be understood by all home care companies.

“Unavoidable” pressure sores are defined as when the client developed a pressure ulcer even though the team had evaluated the client’s clinical condition and pressure ulcer risk factors; defined and implemented interventions that are consistent with client needs, goals, and recognized standards of practice; monitored and evaluated the impact of the interventions; and revised the approaches as appropriate.

“Avoidable” pressures sores are termed so because the clinical team was at fault because the process above was not implemented.

Pressure sores will be an unfortunate reality for many of your clients that are at high risk, such as those that use a wheelchair or are bed bound. You can use the CMS definitions as a starting point “checklist” to make sure that your company does everything possible to prevent, address and document pressure sore issues.

It is a good idea to assess each client for pressure sore risks at their first caregiver visit. Provide all of your caregivers with basic training about signs of pressure sores and sore prevention. A handy one page checklist tucked in a client journal can keep caregivers refreshed to this often overlooked, but serious issue.

How to Avoid Medicare Marketing Scams

The new post on the Private Duty Today blog has a great article about helping your clients avoid Medicare marketing scams. Click here for more information.