Medicare Secret Shoppers

[policy doctor]

Just great...so maybe now we need to video tape mktg meetings so you can prove you're innocent!

Well in another year many more folks will shake out of this market as Ma's go network and raise premiums while shutting down freebies like nurse hotline/gyms/toiletries and dental.
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Retread!!

Are you now a secret shopper and those were your answers?

 

[insurance0707]

If CMS would put 1% of the effort into looking into Medicare fraud from medical suppliers billing Medicare for things never supplied, doctors charging for procedures that were never performed, etc. etc. than checking on agents to see if they're serving light snacks or food, giving away gifts that are more than $15, saying verbatem "if the provider agrees to the terms and condtions, blah blah blah Medicare might not be in so much trouble financially.

Did anyone see the 60 minutes report last night? It was about how rampant Medicare fraud has become. Medicare doesn't have the staff to investigate like they should. They said that 60 billion a year is from Medicare fraud. Maybe they should have the secret shoppers helping them.

 

[AJAX]

If CMS would put 1% of the effort into looking into Medicare fraud from medical suppliers billing Medicare for things never supplied, doctors charging for procedures that were never performed, etc. etc. than checking on agents to see if they're serving light snacks or food, giving away gifts that are more than $15, saying verbatem "if the provider agrees to the terms and condtions, blah blah blah Medicare might not be in so much trouble financially.

Did anyone see the 60 minutes report last night? It was about how rampant Medicare fraud has become. Medicare doesn't have the staff to investigate like they should. They said that 60 billion a year is from Medicare fraud. Maybe they should have the secret shoppers helping them.

Hilarious! Good points.

I wonder if we can find that 60 minutes report on YouTube?

60 Billion is a huge figure; that would fund almost half of the "public option."

I wonder how much fraud private companies experience?

 

[Mr. Bill]

I didn't look on youtube, but here it is:

Watch 60 Minutes, 10.25.09: 60 Minutes Full Length Episodes Online | Free on Fancast

 

[insurance0707]

Thanks for posting the 60 minutes....agents, if you haven't watched this episode, you really should. When CMS says they don't have the funds or people to monitor the fraud thats going on with suppliers and doctors ripping off Medicare, think of all the people and funds their putting into secret shoppers. CMS could cut the fraud in half if on each EOMB statement they send out they just wrote CMS is being defrauded 60 billion a year...please do your part in helping us stop this....please look over your statement carefully and make sure these services were provided to you.

 

[Crabcake Johnny]

My friend's wife is a secret shopper for Sears - has been for over 10 years. Scary stuff when talking to her. She obviously knows other secret shoppers and says a lot are just bitter human beings - their only goal is to "bust" employees and give bad reviews.

I can see the same for CMS shoppers - some bitter senior who hates the insurance industry asking either loaded questions or putting their bias into the reports.

If I was doing a group presentation I'd have my camcorder set up and running.

 

[AJAX]

Wow! That 60 minutes report was well done. It is crazy how easy it is to commit fraud on Medicare. I don't know what is worse the criminals or the government, who seems to not care enough to follow up or put enough manpower to fight the fraud.

That 60 billion is not the government's, it is ours. Taxpayers are losing the money.

 

[retread]

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Retread!!

Are you now a secret shopper and those were your answers?

ROTFLOL!!!

FWIW... I had a seminar last Wednesday. The day before, just as I was arriving at an appointment, my cell phone rings. A guy identified himself as a representative from CMS and wanted to know if I was going to have my seminar as scheduled. I told him, definitely! He said he might be there... maybe, maybe not. I think it was a cheap way to try to put me on notice... he didn't show up.

 

[policy doctor]

RE: camcorders.. yep..when someone asks questions, have the camera videoing the person. Liars don't like to have their pics taken.

Re: medicare fraud. Had a client tell me this story. His brother was involved in a billing business and uncovered this fact. Doctors had discovered that by unbundling their service rendered, they earned more.

E.G. take knee replacement. Instead of coding the bill as one surgery for knee replacement, which is what they are supposed to do, some got creative and charged one amount for cutting skin, another for sawing bone, still another for sutures,..etc. You get the point. ( Reminds me of these dentists' charges. ) That is how they spiked their reimbursements.

 

[ronmelton3]

Anyone heard anything about secret shoppers in the home this year?
I got a compliance notice from Humana stating that if you suspect that someone is from CMS, that you DO NOT ASK them if they work for CMS? Anyone have an idea, what would happen if you did? Can you say entrapment!