Maine news, sports, weather | Kennebec Journal, Augusta, Maine

Seniors ready to battle Medicare fraud

By Meghan V. Malloy mmalloy@centralmaine.com
Staff Writer

The fight against Medicare fraud is being taken into the hands of those most affected by it -- senior citizens.

"Health care fraud is alive and well, even in Maine," said Betty Balderston, statewide coordinator for the Maine Senior Medicare Patrol. "I say 'even in Maine,' because people probably figure it can't or doesn't happen here."

The patrol of 70 volunteers was established and is funded by the U.S. Administration on Aging, a branch of the federal Department of Health and Human Services.

Volunteers, the majority of them age 65 to 70, perform tasks to prevent Medicare fraud, such as speaking to target groups and doing one-on-one health care counseling, Balderston said.

There are 54 Medicare Senior Patrols in the United States, Balderston said.

In Maine, volunteers come from "all walks of life," she said. "Some are retired (and) some still work."

Maine's patrol works hand in hand with Legal Services for the Elderly, a nonprofit group that receives some funding from the federal government.

Though most major health care fraud investigations are put into the hands of state and federal agencies, consumers and the Senior Medicare Patrol are often the first to find the red flags, Balderston said.

In the last two months, settlements in the million-dollar range have been made by Aroostook County health care providers for improper billing and two people, from Auburn and Portland, were indicted on federal charges of health care fraud.

Since January 2009, the federal government has reported recovering some $2.2 billion from health care fraudsters through civil court judgments. In total, however, Medicare fraud is thought to cost taxpayers more than $60 billion annually, according to law enforcement estimates.

Balderston said the complaints brought to her office are "billing oversights that we can usually correct," but sometimes, a complaint raises red flags.

"If the statement lists charges for services that were never provided, or if people report they're receiving medical supplies they never ordered, that gets forwarded to the Administration on Aging," she said. "It's all about inconsistencies."

Many members of the Senior Medicare Patrol have had some prior experience working with Medicare, especially when it comes to aging parents.

Sally Curran, of Manchester, is one such volunteer.

"About six or seven years ago, I was helping my parents' take care of their Medicare," she said. "I noticed there were discrepancies in their statements. I knew there happened to be charges on there I didn't agree with, but didn't know what to do."

An newspaper ad piqued her interest, and after a three-day training course in Portland she started giving presentations on how to self-prevent health care fraud. She spoke to groups including the Rotary Club, the Margaret Chase-Smith Home and the Maine Association of Retirees.

"Anyone who wants a speaker about this, I'll go to speak to," Curran, 69, said. She also fields calls from individuals who believe they have found inaccuracies on their statements.

Curran, a retired educator of 25 years, is also a member of the Senior Medicare Patrol's advisory council.

"There is a lot of waste, fraud and abuse with Medicare -- a lot," she said. "It'd be great if more people got involved, even by doing simple things like reading their statements and tracking their appointments and charges that come with it."

As federal lawmakers mull a health care overhaul, Balderston said its passage, though "wonderful," will open the doors to Medicare scammers.

"Anytime there's a major change to our federal health care system, it's subject to fraud," she said. "Unfortunately, there are people out there in the business of scamming other people. And with our baby boomer population aging into Medicare, our work is just that much more important."

Maine is one of the oldest states in the nation. According to 2008 federal government statistics, 15 percent of Maine's 1.3 million people -- approximately 195,000 people -- are older than 65.

Meghan V. Malloy -- 623-3811, ext. 431

mmalloy@centralmaine.com