Senior group helping fight billing fraud
By Robbie Dingeman
Advertiser Health Writer
A little-known group of senior citizen volunteers is playing an important role in helping officials crack down on Medicare fraud and abuse, while Hawai'i medical providers have been ordered to pay back nearly $5 million in Medicare payments in the past two years.
• Keep a record of your doctor/hospital visits. • Keep your Medicare/ Medicaid number private. • Review your Medicare statement to see that it matches your care. • Don't allow advertising to influence your decisions about healthcare. • Ask questions so you understand your Medicare benefits. • Call SageWatch at 586-7281 for more information. Source: State Executive Office on Aging
The SageWatch program has elderly residents putting their peers on the alert for any suspicious billing by healthcare providers. Regulators say they rely heavily on consumers to blow the whistle on questionable health-insurance practices.
Prevent fraud by providers
"The vast majority of the cases we start come from people. That's our front-line offense," said FBI supervisory Special Agent Clyde Langley, who is in charge of the bureau's white-collar crime unit for Hawai'i.
The FBI says two people in Hawai'i were charged last year with Medicare fraud, two were convicted and $3.9 million was ordered in recoveries and restitution.
For 2001, the federal Office of Inspector General reported $950,000 in court-ordered paybacks, four criminal indictments and four defendants convicted of healthcare-related charges.
While no records show how much of that can be attributed to SageWatch efforts, enforcement gets an "essential" assist from the volunteer group, Langley said.
SageWatch is the Hawai'i name for the senior Medicare patrol project, which is operated by the state Executive Office on Aging but paid for through the U.S. Department of Health and Human Services Administration on Aging. The Hawai'i program has about 60 volunteers and annual budgets of $150,000 to $200,000.
When people are watching what the government is billed for, or checking the medical statements of family members, they often spot problems, Langley said. "Somebody in the public sees something that doesn't look right," he said.
One example of alleged fraud is outlined in a class-action lawsuit against a local pharmaceutical company accused of reselling prescription drugs. The company allegedly accepted pills back from nursing homes and put them into bulk bottles or relabeled them for sale, said plaintiff attorney Tom Grande.
"I was horrified when I found out about the drug company reselling drugs that had been returned from other patients," said plaintiff Francis Markham, whose late sister, Eleanor Wallwork, lived in a Hawai'i Kai care home from 1996 until her death in 1999.
"My sister spent her last days getting medication that may have been sold many times. This shouldn't happen to anyone in a nursing home."
Grande estimated 4,000 people may be in the group affected by the case.
Hawai'i Deputy Attorney General Christopher Young said the federal government spends nearly $700 million in Hawai'i on Medicaid, which reimburses the needy and disabled for healthcare services, and another $710 million on Medicare, federal health insurance for the elderly.
Young said SageWatch volunteers show seniors how to review their medical statements to see they aren't billed for a service they didn't receive, or how to question a charge they don't recognize.
SageWatch volunteer Charlie Clark of Kailua, a retired federal employee, helps teach other seniors how to prevent fraud and abuse of federal Medicare/Medicaid programs.
In his four years with the program, Clark, 76, has explained how fraud can happen and how to avoid it, and helped straighten out some mistakes.
Typically, he talks at churches, meetings and community centers about the federal benefits programs for the elderly and the poor.
At one meeting in Wai'anae, he met a man who had moved here from New York. He had been ill, and Medicare paid for a hospital bed that helped him recover. The bed was shipped to O'ahu with the rest of the family's goods, but Clark's talk made him realize that Medicare laws required him to return the bed.
Clark helped the man resolve the problem without an expensive shipping bill by linking him to federal officials. "You can get yourself into real trouble," Clark said.
"We sort of act as the intermediary, so people don't get caught up in the Mainland bureaucracy," said Deborah Hanson, SageWatch program coordinator. "They can talk to a real person here in Hawai'i."
Reach Robbie Dingeman at rdingeman@honoluluadvertiser.com or 535-2429.
Correction: Deborah Hanson's first name and title were left out of a previous version of this story.
