There are resources available to help prevent wrongdoers from successfully targeting vulnerable patient populations.
A dirty little secret of the long-term care industry is that the problem of identity theft arises more often than is reported.
In all fraud, there is the fraud triangle. The triangle sides are pressure, opportunity, and rationalization.
Let’s start with pressure. Minimum wages have not increased since 2009. Most of the nurses and aides working in long-term care are paid minimum wage. Additionally, most long-term care providers offer little in the way of benefits.
The opportunity is huge. You have 100 or more people who usually have stopped filing taxes or checking their credit reports. Caregivers have patients’ names and birthdates, at a minimum, from medical records. Mail and visits from relatives can provide other information like Social Security numbers.
There is a cottage industry of dishonest tax preparation services that can easily file fraudulent returns and have refunds sent to criminals.
One interesting spin on identity theft is the use of the victim’s insurance benefits. Under this scam, the thief uses the elderly patient’s Medicare card to get medical benefits under the Medicare and Medicaid programs.
The rationalization makes this scarier. The criminals think to themselves that the Internal Revenue Service (IRS) will never make these old people pay back the money from the filing of fraudulent tax returns, and credit card companies will simply write off the balances. If they use the victim’s insurance benefits, they think, Medicare and Medicaid can afford to cover the loss.
They also may feel that elderly nursing-home patients will never be seriously impacted by low credit scores.
Here is something that shocked me, though. As mentioned, identity theft in long-term care institutions is much more common than is reported.
What can you do if you have a loved one in a nursing home or other long-term care facility? Review the medical benefit letters of your loved ones. Questionable charges? Contact your healthcare provider first to see if it’s a mistake. If your issue is not resolved by your provider, report the questionable charges to 1-800-MEDICARE or contact your local Senior Medicare Patrol for assistance: 1-877-808-2468 or www.SMPResource.org.
Suspect Medicare Fraud? Contact the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) fraud hotline:
Online: oig.hhs.gov/fraud/hotline
Phone: 1-800-447-8477 (1-800-HHS-TIPS)
TTY: 1-800-377-4950 | Fax: 1-800-223-8164
The U.S. Department of Justice (DOJ) announced a settlement of up to $100 million with Independent Health, a Medicare Advantage (MA) plan serving upstate New
Well, if ever there was a time of great uncertainty in healthcare, it is right now. The new administration will bring new leadership with new
Please log in to your account to comment on this article.
Prepare your organization for the 2025 OPPS updates with expert insights from Tiffani Bouchard, CCS, CRCR, a Revenue Integrity Professional with over 30 years of experience. This webcast will address critical challenges in charge capture and coding, providing clarity on APC policies, C-APC packaging, exclusions, and payer-specific requirements. Attendees will learn actionable strategies to ensure compliance, optimize reimbursement, and mitigate risks of claim denials. Gain the knowledge needed to implement updates effectively, educate your team, and maintain seamless revenue cycle operations in the face of evolving OPPS complexities.
Join Beth Wolf, MD, CPC, CCDS, for an in-depth webcast on the FY2025 spinal fusion MS-DRG updates. Discover key changes in DRG classification, understand impacts on documentation and CMI, and learn strategies to ensure compliance.
Join Angela Comfort, DBA, MBA, RHIA, CDIP, CCS, CCS-P, as she presents effective strategies to strengthen collaboration between CDI, coding, and quality departments in acute care hospitals. Angela will also share guidance on implementing cross-departmental meetings, using shared KPIs, and engaging leadership to foster a culture of collaboration. Attendees will gain actionable tools to optimize documentation accuracy, elevate quality metrics, and drive a unified approach to healthcare goals, ultimately enhancing both patient outcomes and organizational performance.
Optimize your outpatient clinical documentation and gain comprehensive knowledge from foundational practices to advanced technologies, ensuring improved patient care and organizational and financial success. This webcast bundle provides a holistic approach to outpatient CDI, empowering you to implement best practices from the ground up and leverage advanced strategies for superior results. You will gain actionable insights to improve documentation quality, patient care, compliance, and financial outcomes.
The 2025 Medicare Physician Fee Schedule brings significant changes to payment rates, coverage, and coding for physician services, impacting practices nationwide. Join Stanley Nachimson, MS., as he provides a comprehensive guide to understanding these updates, offering actionable insights on new Medicare-covered services, revised coding rules, and payment policies effective January 1. Learn how to adapt your practices to maintain compliance, maximize reimbursement, and plan for revenue in 2025. Whether you’re a physician, coder, or financial staff member, this session equips you with the tools to navigate Medicare’s evolving requirements confidently and efficiently.
Dr. Ronald Hirsch provides critical details on the new Medicare Appeal Process for Status Changes for patients whose status changes during their hospital stay. He also delves into other scenarios of hospital patients receiving custodial care or medically unnecessary services where patient notifications may be needed along with the processes necessary to ensure compliance with state and federal guidance.
Healthcare organizations face complex regulatory requirements under the No Surprises Act and Price Transparency rules. These policies mandate extensive fee disclosures across settings, and confusion is widespread—many hospitals remain unaware they must post every contracted rate. Non-compliance could lead to costly penalties, financial loss, and legal risks. Join David M. Glaser Esq. as he shows you how to navigate these regulations effectively.
Protect your facility from unwanted audits! Join Becky Jacobsen, BSN, RN, MBS, CCS-P, CPC, CPEDC, CBCS, CEMC, and take a deep dive into both the CMS and AMA guidelines for reporting post operative pain blocks. You’ll learn how to determine if the nerve block is separately codable with real life examples for better understanding. Becky will also cover how to evaluate whether documentation supports medical necessity, offer recommendations for stronger documentation practices, and provide guidance on educating providers about documentation requirements. She’ll include a discussion of appropriate modifier and diagnosis coding assignment so that you can be confident that your billing of post operative pain blocks is fully supported and compliant.
Copyright © 2025 RACmonitor. Powered by MedLearn Media.
Happy National Doctor’s Day! Learn how to get a complimentary webcast on ‘Decoding Social Admissions’ as a token of our heartfelt appreciation! Click here to learn more →
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
