As the recent arrest of sixteen individuals in South Texas show, Medicare and Medicaid fraud is an ongoing problem, both in the state of Texas and nationwide. While the coverage is essential for millions of American seniors, and universally applicable those individuals meeting age restrictions, criminals also see this large body of elderly participants in the Medicare and Medicaid system as a large source of income for ongoing criminal enterprises. As the recent arrests for Medicare and Medicaid abuse indicate, common patterns of crimes involve using elderly patients, or even merely the patient’s information, to file fraudulent claims with insurance companies, with the criminal organization retaining reimbursement amounts for services never rendered. Moreover, over-billing or over-providing unnecessary services by way of using an otherwise unsuspecting elderly person, is common practice both nationwide and in the state of Texas.
According to officials with the Texas Senior Medicaid Patrol, an entity tasked with monitoring Medicaid fraud and abuse involving elderly patients, organized criminal entities frequently employee one or more licensed medical doctors, while seeking out elderly patients. Once the patient-doctor care relationship is established, these doctors and the associated healthcare groups bilk Medicare and Medicaid for numerous unnecessary medical services and goods that are never delivered to elderly patients, who are less likely than other populations to notice or know how to respond to the ongoing fraud. In almost all cases, misappropriation of the elderly person’s identity occurs, and in limited instances, failures to provide adequate, but required medical care to the patient may also occur. Given the financial losses incurred by the government in these cases, numerous investigative agencies are in place both at the federal and state level in Texas to investigate suspected instances of Medicare or Medicaid fraud.
For seniors, or those tasked with ensuring the proper healthcare treatment for their loved ones, the following could potentially be indicative of Medicare and Medicaid fraud perpetrated in the name of your loved one:
- While legitimate clinics catering to elderly populations do exist, those medical offices that primarily deal exclusively with elderly clients, while offering a wide variety of services and goods to these patients should be watched carefully
- Extensive billings made to your loved one outside the scope of their normal or historical treatment needs are the most obvious signs of ongoing fraud
- Clinics or providers that fail to provide or conduct previously billed testing or goods to elderly patients are strong indicators of fraudulent practices
- Providers that require inordinately frequent trips by the elderly patient for visits, follow-ups, and external site testing are also common practice employed as part of medicare fraud involving the elderly
The unfortunate reality is that elderly patients are essentially a vulnerable population, especially in terms of tracking the finer details of their healthcare paperwork and billing. In this sense, while Texas laws are in place specifically to protect elderly populations from these and other forms of abuse, the reality is that criminals will always seek to exploit this vulnerability as well. If you suspect your loved one may be victimized by an ongoing or past Medicare or Medicaid fraud, consulting with an attorney is highly advisable, as it will ensure that your elderly loved one remains eligible for federal health benefits for elderly persons.