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Another Voice: Consumers have a role in fighting medical fraud

By Arthur G. Wingerter

In recent days the FBI’s Medicare Fraud Strike Force arrested more than 240 people, including health care professionals, for their alleged participation in Medicare fraud schemes involving more than $700 million in false billings. The arrests were part of a coordinated operation in 17 cities, making it the largest-ever health care fraud takedown in terms of both loss amount and number of arrests. Imagine what that $700 million could fund in patient care, medical equipment, prescription drugs or coverage for the uninsured.

About $3 trillion a year in the United States is spent on health care. According to an estimate cited by the U.S. Senate Special Committee on Aging, $60 billion to $90 billion from the taxpayer-funded Medicare system is lost annually to fraud. That doesn’t include additional health care dollars scammed from individuals and their employers who fund private health insurance. Think what an infusion of $60 billion to $90 billion could do for our nation’s health care system.

Univera Healthcare, like all health insurers, works closely with law enforcement and regulatory agencies to identify abuses, recover funds and aid in prosecution. We partner with the Medicaid Fraud Control Unit, the U.S. attorney, the FBI, the New York State Department of Financial Services and Office of the Medicaid Inspector General, and also local law enforcement and district attorneys.

Our members and their employers need to be just as vigilant as we are about spotting health care fraud, since it’s not only their tax dollars at stake but also their hard-earned premium dollars. Here are common-sense tips for all health care consumers.

If you’re shopping for health insurance for the first time, don’t provide personal information to anyone unless you’ve confirmed that the insurance company with whom you’re speaking or emailing is legitimate and licensed to do business in your state. Always request copies of policies and applications to verify your coverage. And follow up by contacting the insurer to verify your application has been processed and your premium payment was received.

If you already have coverage, treat your member ID card as you would your driver’s license or credit card: Keep your ID number secret. If crooks can steal that number, they can involve you in scams or steal your medical identity.

If you suspect health care fraud, call the customer service number on your health insurance ID card. Another option is to call the New York Attorney General Consumer Frauds and Protection Bureau at 1-800-771-7755. For Medicare Advantage plans or the Medicare Prescription Drug Benefit, call the MEDIC Fraud Hotline at 1-877-772-3379.

Arthur G. Wingerter is president of Williamsville-based Univera Healthcare.