State wants seniors to help in detection of Medicaid fraud

Tuesday, Feb. 22, 2000 | 10:52 a.m.

CARSON CITY -- A joint federal-state effort was kicked off today to recruit senior volunteers in Clark County to help ferret out and cut the estimated $109 million lost annually to fraud in the Medicare program in Nevada.

A three-year federal grant of $410,000 will finance the effort to train seniors on detecting suspected or fraudulent activities on their Medicare or Medicaid bills. Jo Anne Embry of the state attorney general's office in Las Vegas will head the program.

"I urge all retired senior professionals in our community to please join our team," Embry said.

The program will start in Clark County and then will be extended to Washoe County and finally to rural Nevada.

The federal government estimates $1 out of $10 spent on Medicare is lost to fraud, waste or abuse. In 1999, $1.1 billion was spent on Medicare in Nevada, of which an estimated $109 million was lost to fraud.

Attorney General Frankie Sue Del Papa said, "The drain to the system as a result of Medicare fraud affects all of us beneficiaries by reducing the quantity and quality of care; honest health care providers and caregivers by decreased funding for vital programs; and all taxpayers by wasting their money." The program, announced at a news conference in Las Vegas, is nicknamed SNAG, or Senior Nevada Advocates on Guard.

Carla Sloan, state director for the American Association of Retired Persons, said she will help recruit volunteers to instruct the senior population on what to look for on their Medicare bills. The volunteers also will be available to review individual complaints.

A hot line will be dedicated to the fraud control project and will handle complaints received electronically or through the mail.

Nevada is one of 36 states receiving grants for the program. So far, an estimated 6,000 volunteers have been trained nationwide and $1.5 million recouped in 1999.

Embry said some of the "red flags" that might signal abuse include billing for services or supplies not rendered; soliciting or receiving a kickback for patient referral; lying about a patient's condition to receive Medicare payments; assigning a more expensive code to the illness to collect more money; and collecting for services not covered by Medicare.

Other signs of possible fraud are billing Medicare patients at a higher rate than other patients; billing for the 20 percent co-payment when it has already been paid by the insurance company, altering claim forms to obtain a higher payment; and billing separately for services that should be included in a single service fee.

If cases of fraud are uncovered, further investigation may be undertaken, and the individual could be prosecuted either criminally or by a civil action seeking a fine and recovery of the loss.

Cy Ryan covers state government for the Sun. He can be reached at (775) 687-5032.