Medicare fraud is on the rise. Criminals are targeting the most vulnerable members of our society: elderly, sick, disabled and immigrant populations. They hope to scam unsuspecting victims and make quick profits. The federal government estimates tens of billions of dollars in Medicare fraud annually.
Deborah Gilman, a registered nurse at Stanford Medical Hospital, heard about these cases of fraud, but never thought her father would fall victim. Jerry is a 69-year-old disabled Vietnam veteran. He’s lived in the same house in Fremont for over forty years with his wife who recently had a stroke. Jerry was exposed to Agent Orange during the war and now suffers from a degenerative disease making it almost impossible for him to walk.
"I can only walk a few feet at a time," Jerry said. "I have to hang onto something. A power chair is medically necessary for me to get around."
With the help of his doctor in February 2012, Jerry ordered a motorized chair from Hoveround designed specifically for his height and weight. It even had a built in cup holder for his favorite beverages. His dream of being able to go outside again was finally becoming a reality. And, Medicare would cover the bill. Everything was falling into place. Or was it?
Little did Jerry know, he was about to embark on a frustrating journey. A chair showed up at his door that he didn’t order from an unknown company. It wasn’t the right color, but more than aesthetics, it was too small. They also sent a back brace that Jerry never ordered.
“I took the chair and drove it around the block and it just didn’t feel right. That’s when I started to get suspicious,” he said.
Jerry’s suspicions increased exponentially when a second chair from the correct manufacturer, Hoveround, was delivered to his home. This chair was the chair he originally ordered. Hoveround explained they couldn’t leave the chair at Jerry’s home because he already had one.
Frustrated and confused, Jerry called the second company and explained they sent him the wrong chair by mistake and an unwanted back brace. He wanted both returned. When the unknown company refused, he decided to get his daughter involved.
Deborah went into action. She got on the phone and started making calls. She quickly realized that something wasn’t right. The company was hostile, claiming they had worked with her father on ordering this chair for the past four years and refused to allow a return. Impossible, Deborah thought, because they only first talked about getting a power chair in 2011. This was no mistake. This was fraud.
“I tried to think positively. It’s probably a mix-up,” she said. “But as I got deeper and made contact with the company that sent the wrong chair I realized somebody had hijacked my father’s account.”
Deborah was furious and extremely disappointed. She thought there were better protections for seniors against healthcare fraud.
“How dare they (the company) take advantage of someone in this situation,” she said.
Deborah worked tirelessly to get to the bottom of the situation. She tried calling Medicare, but they explained there was little they could do until the second company billed Medicare and the billed was paid. Then an alleged “fraudulent act” would have been committed.
That answer didn’t sit well with Deborah. She ran across a government organization known as Senior Medicare Patrol, a federally funded anti-fraud program that relies on volunteers.
They immediately took up the Gilman’s case and launched an investigation into the suspected fraud, working in conjunction with Centers for Medicare and Medicaid Services office.
SMP contacted the bank who was about to issue a check to the second company and convinced them to hold payment. That’s when SMP started playing hardball.
“SMP contacted the company and informed them this was a fraudulent claim and they needed to pick up the wrong chair,” Deborah said.
Eventually, SMP helped resolve the situation. Jerry got the chair he needed. But the allegedly fraudulent company never issued an apology. It is currently under investigation by Centers for Medicare and Medicaid Services.
Deborah has some advice for seniors. Stay informed. Know exactly what your doctor is ordering for you. Always read your billing statement. And when in doubt ask questions. Never accept an unknown item.
“If there is any question when the medical equipment arrives at your door, refuse that shipment. Be a savvy customer,” she said.
Today, Jerry Gilman has a new lease on life. He can move around without difficulty. He can go outside, drive around the block on his motorized chair and feel whole again. He owes it all to Deborah.
“I’m very thankful for what my daughter’s done. She’s very intelligent. She’s good on the computer. I’m not that talented with computers” he said with a chuckle.
Deborah Gilman was interviewed by our reporter Gina Scialabba. The Gilman’s case is under currently under investigation. It took over a year, but Mr. Gilman finally has the correct motorized chair. If you or someone you know thinks they have been a victim of Medicare fraud, please contact Senior Medicare Patrol at www.cahealthadvocates.org. The California Medicare fraud hot line is 855-613-7080.