I got my first up-close-and-personal glimpse of Medicare fraud Monday, prompting an at times troubling effort to report same.
Perhaps this was my penance for having enjoyed an otherwise glorious day, beginning with eating a snoball (coconut, marshmallow, chocolate cake, cream filling treat) breakfast with granddaughter No. 3 and progressing through mowing the lawn (for the last time!) at my late mother’s house, then taking a 30-plus mile ride in the Mustang convertible (top-down).
Returning home from the drive, I discovered that the wife had brought in a pile of mail, including three Medicare claims summaries (NOT A BILL, NOT A BILL, NOT A BILL).
Two were legitimate, for actual medical treatment for me and my wife. The third was not.
The scam requested payment from Medicare for not one, but two urinary catheter insertions, allegedly performed at some facility in Alexandria, Kentucky.
Having had zero urinary catheter insertions in quite some time, and not having been to Kentucky for maybe 20 years, I was pretty sure this was a bogus billing.
Each was a $1,990 charge by the provider, winnowed down to Medicare paying $1,458.24 for each and me possibly being on the hook for $372 times two.
I would not actually have needed to have paid anything had this been legitimate since I have a Plan G supplemental policy and already had hit my Part B Medicare deductible.
But it raises the hackles on my neck that my name might be used in a scam to defraud not only Medicare, but my Highmark Medigap insurance provider.
The call to Medicare was the easy part, which I had not expected. The first man handled things quickly and as soon as I mentioned a catheter and this particular provider, he confirmed fraud, not some honest mistake in billing.
I had to hold to talk to another person to complete the report. This was a bit more cumbersome, including a wait on hold and a woman who seemed a bit overwhelmed by it all. But the report was made and it was time to get in touch with Highmark.
Funny thing about fraud reporting phone numbers, they tend to answer almost any time you call, as opposed to general customer service numbers.
To my surprise, the first number I called for Highmark answered, but put me in limbo, without any kind of verbal clues as to progress of things. After five minutes, I hung up and dialed a second number.
This call was answered in a relatively short time, but by someone whose attitude suggested she was confused and just plain doing me a favor.
Allow me to interpose that I am more well-versed than most on health insurance, having obtained a state license for same following retirement from newspapers, and also having used that license to work seasonally servicing both Medicare and Affordable Care Act plans.
I know the subject and I know how to treat people on the phone. The Highmark experience (she kept interjecting Gateway into the conversation) was not a prime example of phone demeanor.
She was abrasive, rude, and committed the classic sin of chastising the caller for interrupting her.
I was answering her question, but she felt I was talking over her. Allow me to assure you, people providing telephone support are taught NEVER, NEVER, NEVER, NEVER talk over the customer or accuse them of this offense.
I felt the need to tell this person that she was making it an unpleasant experience and since I’d clearly told her umpteen times I was a Highmark customer, quit asking me for a Gateway ID. I told her if I had the wrong number, please tell me.
No, she said, I had the right number. Apparently I just had the wrong person, as in someone having a bad day and eager to be a super spreader.
I was trying to save Highmark money, so you might think the response would have been higher on the gratitude scale.
Alas, I had to satisfy myself with having done the right thing. When we finally got our work together completed, I took my case number and instructions on what to do if no one had contacted me by Nov. 6, and returned to watching the Phillies-Diamondbacks NLCS Game 6.
It occurred to me that just maybe my last customer service contact was a Phillies fan, one doubly miffed at not being able to watch the game and also perhaps knowing that her Phillies were trailing late.
Sam Ross Jr's site 