Retirees to help cut Medicare billing errors

By Paula E. Hartman-Stein, Ph.D.

Psychologists currently in practice and retired clinicians have new avenues to help prevent Medicare fraud and erroneous billing.

In fiscal year 2003 the Department of Health and Human Services (HHS) awarded $4.5 million to 52 projects under Operation Restore Trust (ORT) in 45 states to train retired professionals to help older Americans become better healthcare consumers and identify billing errors, according to an HHS press release.

Shirley Merner, state coordinator of ORT of Iowa, explained that in 1997 a pilot project began in several states as a result of survey data showing Medicare losing 26 billion a year from erroneous billing and actual fraud. In the first year of the effort HHS gained SI 0 for every dollar spent.

The volunteer program does not investigate claims. “We do not audit medical or psychiatric charts. We teach beneficiaries to be responsible consumers,” Merner said, The volunteer professionals emphasize how to interpret Medicare billing statements and the need to raise questions. “This is a highly, highly effective grassroots effort,” according to Merner.

         Medicare identity theft is one aspect of healthcare fraud especially frightening to professionals. Merner speaks to professional groups warning the healthcare providers not to print their provider number on billing statements and advising Medicare providers to conduct background checks on all of their employees and contract people such as billing and cleaning services. She described a scam in which a cleaning firm employee copied a provider’s license and sold it on the black market. Identity theft rings through billing services have billed for Medicare services not conducted by the professional, directing the payments to themselves, according to Merner.

             To avoid outrageous fraud attempts, she even suggests that professionals try to determine whether their trash pick-up services have a good reputation in the community. Her frequent mantra is to “shred and seal” all financial documents or papers with provider numbers. “Overlooking simple things can lead to the erosion of a professional’s reputation,” she said.

Retirees can also help beat such fleecing of America by using their clinical skills by advising beneficiaries. Richard Tiemeyer, MA., a 67 year old retired mental health counselor from Burlington, IA, regularly conducts seminars for the community on how to read Medicare statements, recognize whether their bills for medical services are legitimate, and choose the best available insurance plan for seniors. Tiemeyer, a volunteer for Operation Restore Trust (ORT) and the Senior Health Insurance Information Program (SHIIP), says, 1 worked as a family therapist, and through my volunteer work I use my professional skills. This is a creative and fulfilling way to be active in retirement.”

Rather than worry about the possibility of Medicare audits on her patient charts, Donna Rasin-Waters, Ph.D., New York City psychologist and Past-President of the New York State Psychological Association’s Adult Development and Aging Division, took action to prevent erroneous billing and documentation mistakes in her own charts.

Rasin-Waters found that she had accidentally billed for a therapy session once for a client who was asleep. Unexpectedly she found sessions that had been conducted and documented but missed in the billing process. “Such mistakes happen, and I believe it is the practitioner’s responsibility to catch and remedy these errors,” she said.

Motivated by an article in the October 2000 edition of The National Psychologist about voluntary compliance of Medicare regulations, Rasin-Waters encouraged a group of 30 independent practitioners of geropsychology in the New York City area to meet together for collegial support and chart auditing.  The psychologists bring in charts for discussions of their nursing homes patients who are receiving long-term psychological treatment or who were making limited change or progress. Small groups of five to six  therapists read the charts to evaluate medical necessity and examine progress notes and treatment plans. “We were all nervous about exposing our clinical notes to each other, but decided that it was better to do it with each other and struggle with difficult issues as opposed to going through an actual Medicare audit,” said Rasin-Waters. “We were collegial but we didn’t spare any feelings.”

         The group generated model notes and tackled tough cases, debating how to know when to stop treatment of elderly nursing home patients who make little to no progress, but who become attached to their therapists. The auditing and documentation methods generated by the New York group are still works in progress. According to Rasin-Waters, “The more that psychologists audit their own work, the better the shape we will be in with the Medicare system. We can really make a difference”

To learn more about ORT, psychologists should contact their local Area on Aging or the Better Business Bureau.  Rasin-Waters can be reached through her email at geronto1ogyres@rocketmailcom

Paula Hartman-Stein, Ph.D. is a geropsychologist and consultant in Kent, Ohio and currently

president-elect for APA Division 12, section II (Clinical Geropsychology), She can be reached through her email: 

 Hartman-Stein, P.E. (2003). Retirees to help cut Medicare billing errors. The National Psychologist, Vol. 12,  No.1, p 8.