When I receive my mother's Medicare Summary Notices, I see a lot of claims that appear suspect. Physical Therapy at a frequency I'm almost certain is inaccurate, claims for Psychotherapy sessions that probably amounted to an unrequested 10 minute phone call with the therapist asking superficial questions like "how are you feeling today?", etc.. Given our experience with this the financial side of this institution, it would not surprise me one bit if their claims were padded. In fact, I would be shocked if they weren't. But it would probably be hard to investigate/prove, so as much as I'd love to see the management of this place get their comeuppance, I'm not sure reporting it is worth the time or bother. And frankly, it probably happens everywhere, so the fraud department is probably oversaturated with investigations anyway. Pursue it? Or let it go?
It's always worth it. It's worth it if they've charged 25 cents over what they're owed.
When my parent was in the nursing home, I scrutinized every bill and statement. Turns out they were not only frauding Medicare, but also us. They got in trouble with Medicare and had to pay back. They also had to refund some money to the estate. This brought me such satisfaction. It's always worth the effort.
With Medicare, the costs have to be billed at exorbitant amounts just so the providers can get SOMETHING for the services, since Medicare pays a tiny fraction of what's billed.
I wouldn't touch this with a ten foot pole if it were me, based on my past history. Plus, you'll be on the phone for GOD knows how long, jumping through who knows how many fiery hoops, all for what? If Medicare wants us to report suspicious activity to them, then they should send us a FORM to fill out and return in the mail. Would make life a whole lot easier for all concerned. Then they can throw it in File 13 and that's that.
A few comments though.
That therapist and the 10 minute call. The call may be 10 minutes but a review of the chart, documenting the call are unseen minutes that the therapist spends for your moms "visit".
PT and or OT surprised me when my Husband was in rehab. I would try to get there so I could observe the Therapy they were doing. Several times I arrived and was told that they were done. The "therapy" was him getting dressed, I guess that qualifies as OT. They may even consider her getting her own lunch or coloring as "active PT"
But you should be able to review the PT and OT notes for the days that you are questioning.
Hospital made some nice money on her sickness and as you will see from her notices these places charge for everything.
I keep the Medicare statements until I get my supplemental ones. The supplemental one shows what Medicare paid and what the supplemental paid and what you may owe. When I get a statement from the provider, I make sure it matches to the supplimental statement. If not I question it. When everything matches up and the bill is paid, I get rid of the Medicare statements. I hate they send out summarys every quarter since its info I have already dealt with.
" With limited exceptions, the HIPAA Privacy Rule (the Privacy Rule) provides individuals with a legal, enforceable right to see and receive copies upon request of the information in their medical and other health records maintained by their health care providers and health plans".