Medicare Fraud Effects All Medicare and Medigap Participants

With attention focused on the current healthcare debate, many citizens are have concerns over the promise of an increase in healthcare bills over the coming year and decades. Medicare participants, especially, stand to see a significant increase in the cost of their healthcare, according to some experts, especially supporters of the Republican party.


In the face of these fee increases, the Florida Department of Health and Human Services has just announced a shocking case of Medicare fraud in Miami-Dade County, Florida. According to a report released by the Department of Health and Human Services Office of Inspector General, Miami-Dade County received about five hundred million dollars for Medicare in-home health care payments in 2008. This amounts to a payment of more than the entire nation combined.

Despite the huge amount of claims from Miami-Dade County, the county only accounts for more than half of the nation’s claims. Moreover, only 2 percent of patients who receive home health care live in the county. The Medicare fraud is not only blatantly obvious, but it is effects for everyone; Medicare fraud amounts to more than $3 billion each year because of false claims.

Medicare fraud comes in many forms. In some cases, agencies have billed the Medicare program for home health services that they claim were rendered for homeless people. IAccording to an article published Monday by the Associated Press, “a large percentage of the patients are diabetics who claim they are blind and bill Medicare for a day and night nurse to give them insulin shots.” However, upon further investigation, the beneficiaries are not actually blind.

“What we’re finding in a lot of the cases is the patients don’t even have diabetes and certainly aren’t blind,” said Kirk Ogrosky, who heads the Medicare Fraud Strike Force across the United States for the Department of Justice. The report indicates that Medicare payments for home healthcare for diabetics in Miami are eight times the national average.

Medicare beneficiaries who participate in the Medicare scams may stand to benefit financially for their services. According to the AP article, patients are paid between $700 and $1,400 for their participation. Eight suspects in Miami were charged with getting $22 million from the system through fraud.

What does this fraud mean for Medicare beneficiaries across the country? It means that the Medicare system pays out a significant amount of money from shared coffers for fraudulent claims, reducing the available money for real claims. As Medicare funds are stretched thin, Medicare payments to providers are ultimately reduced and Medicare fees for beneficiaries are ultimately increased.

To help protect themselves against the negative side effects of Medicare fraud, many Medicare participants would benefit by enrolling in Medicare Supplemental insurance plans that will help to cover the costs of many healthcare services and products that are not covered by Original Medicare. Medicare Advantage plans may also provide Medicare participants with more options when it comes to getting the right healthcare for their needs.

Ultimately, Medicare fraud costs the nation billions of dollars and increases fees for all participants. However, by taking steps to protect themselves from these fee increases, many Medicare beneficiaries can minimize the effects of Medicare fraud on their own pocketbooks.

Medicare participants have until December 31, 2009 to make changes to their Medicare plans for 2010, including the addition of Medicare Supplemental insurance.

About the Author: By Wiley Long – President, – The nation’s leading independent agency specializing in Medicare Supplemental Insurance. Our professional MediGap advisors look forward to the opportunity to help you get the best insurance for your healthcare needs.

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