We appreciate being able to post this Guest Blog written by Erin Weir, Healthcare Consumer Protection Coordinator with AgeOptions, the Area Agency on Aging of Suburban Cook County.
The Illinois SMP Program at AgeOptions has received a number of complaints involving home health agencies in the south suburbs. We would like to alert residents in the community about these issues so that they can protect themselves from, detect and report fraud.
We are hearing the there are companies going door-to-door and offering “free” services in exchange for people’s Medicare or Social Security numbers. Some of these companies are also calling people on the phone and telling them that their “free” services are a new benefit under Medicare. We also are hearing that there are companies recruiting children and/or family members to obtain their loved ones’ Medicare or Social Security numbers and giving them to the home health company in exchange for payment (this may be marketed as a “job” or way to get paid for caring for your loved one).
Once these companies obtain someone’s Medicare or Social Security number, they bill Medicare for thousands of dollars in services that they are NOT providing.
We would like Illinois residents to understand that cases like these are fraud, and they put the individuals involved in danger of identity theft and loss of health care benefits.
For example, if one of these companies bill for physical therapy on someone’s Medicare account and that person actually needs physical therapy later, Medicare may not pay for it.
We would like to share the following tips and information about Medicare-covered home health care to help consumers avoid being victims to these scams:
NEVER give your Medicare, Social Security or Medicaid number away to anyone who calls on the phone or comes to the door – no matter what reason they give or what services they offer. Anyone who solicits business over the phone or door-to-door is not from a legitimate organization.
If you need services or care, contact your doctor. Your doctor should be able to help you find a legitimate provider of those services. Any care that you receive should be ordered by your doctor – do not listen to companies that tell you that “their doctor” can sign off on the care.
Medicare only pays for home health services when someone is homebound and needs skilled care. This means that the person must have a very difficult time leaving the home and that the person must need physical therapy, speech therapy, occupational therapy or skilled nursing services (IV treatments, wound care, etc.) These services must be provided by skilled personnel employed by the home health agency – not the patient themselves or a family member. If the only services that a person needs are assistance with activities of daily living such as bathing, dressing, cleaning, etc. this does not qualify as skilled care. If a home health agency offers aide services for “free” but takes your Medicare number, they are likely billing Medicare fraudulently for skilled services that they are not providing and they are using up your benefits!
If anyone has experience an issue like those mentioned above, please report it to the Illinois SMP program at Age Options by calling 1-800-699-9043 and asking to speak to an SMP staff member.
Additional resources on Medicare and home health are available on our website at www.illinoismp.org. Click on “Illinois SMP Materials” and scroll down to “home health.”
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