This piece was written by JFS Project Specialist Brian Strauss and JFS Development Associate Bebe Santa-Wood
Waking up one day and discovering your identity was taken to commit fraud can feel like a living nightmare. Victims feel angry, sad, and confused, and for a victim of Medicare fraud it feels especially hurtful. The healthcare sector has long been a susceptible area to fraud, as thieves take advantage of individuals struggling with challenging times. Many victims are chronically ill, low-income seniors who simply want to stay healthy. Like most people, they put their trust in a doctor or healthcare facility, expecting to feel safe and cared for. Having experienced fraud, a victim may feel like they can no longer trust anyone, something no one should have to experience.
While most health care providers that accept Medicare and Medicaid value and protect their clients, there can always be exceptions to the rule. A 2011 study by the Medicare News Groups estimates that 3-10% of all Medicare billings may be tied to fraudulent claims. The possibility, however small, is certainly a reality for the many victims of Medicare fraud. Perpetrators have many covert ways of committing fraud, including using victim’s social security info to claim benefits, acting as a false provider and offering benefits or a program that do not exist, or simply billing for services you never received.
This past Monday, Randall J. Davis gave a talk at the JFS/Weinstein JCC speaker series Food for Thought on the growing issue of Medicare fraud. Randall Davis works for the Virginia Medicaid Fraud Control Unit and Elder Abuse & Neglect Squad. Randall recounted how the state is working to save the billions of dollars that could be lost to Medicaid fraud. The Virginia Attorney General’s office has made it a priority to combat thieves trying to rob a system that protects the most vulnerable in our community.
Beyond financial fraud, seniors as a group are particularly susceptible to other forms of abuse, including physical, mental and emotional neglect. Randall spoke about elder abuse and how to help combat this phenomenon. Signs a loved one may be abused include unsanitary/unsafe housing, unexplained bruises, welts, breaks or fractures, malnourishment, lacking necessary care to stay healthy, or going without proper supervision. Neglect can occur in many situations, from nursing facilities to one’s home, and perpetrators of abuse could be anyone who cares for the victim in one form or another. Randall noted that if you suspect abuse, you should try and speak with the person alone, away from a potential abuser, and seek help as soon as possible. The Virginia Office of the Attorney General has a group, the Elder Abuse and Neglect Squad who are available as a resource for support, information or to report neglect.
Randall discussed the rising popularity of seniors aging in place at home as one way to lessen risk of elder abuse. However, caregivers can still get burnt out, so they should seek support groups (like the ones we have at JFS) or respite by utilizing Aides or short term day care. While fraud and abuse are real possibilities, being vigilant and keeping an eye out for loved ones, can go a long way in prevention.
If you suspect abuse or fraud you can contact the Elder Abuse and Neglect Squad at 1-800-371-0824 or email MFCU_mail@oag.state.va.us
If you or a loved one are interested in Respite services at JFS you can find more info at: http://jfsrichmond.org/home-care/respite/