Medicare Fraud in Nursing Homes Is the New York StateWide Senior Action Council's "Medicare Fraud of the Month for July"

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ALBANY, N.Y., July 15, 2025 /PRNewswire/ -- The New York StateWide Senior Action Council (StateWide), a 53-year-old non-profit organization dedicated to serving the needs and well-being of our State's approximately 2.5 million senior citizens today announced its Medicare Fraud of the Month for July: Medicare Fraud in Nursing Homes.

The StateWide Fraud of the Month is a component of the Senior Medicare Patrol (SMP), the definitive resource for New York State's older adults and caregivers to detect, prevent, and report healthcare fraud, errors, and abuse. StateWide is New York's grantee/administrator for this Federal Program.

"Medicare doesn't generally pay for long-term nursing home care. However, Medicare Part A covers medically necessary, short-term care in a skilled nursing facility (SNF). Because of the complexity of SNF coverage, Medicare is often a target for fraud, errors and abuse," explained Maria Alvarez, Executive Director of the New York StateWide Senior Action Council. "We have compiled a list of what Seniors need to look for to prevent Nursing home Medicare fraud," she added.

What can seniors and their health care providers do to stop nursing home care fraud?

• Review Medicare Summary Notice (MSN) or Explanation of Benefits (EOB)
  • Check that the services billed to Medicare match what was actually received.
  • Look for duplicate charges.
  • Watch for services or therapy not provided.
  • Check for skilled nursing charges after a discharge date.
• Don't sign forms not understood
  • These include Advance Beneficiary Notices (ABN), Medicare Outpatient Observation Notices (MOON), or any form that is blank.
• Work with the doctor
  • To determine whether the services are medically necessary and how long services should be provided, based on condition and recovery goals.
• Never accept gifts for choosing a facility
  • Such as money, gift cards or groceries, in return for choosing a nursing home.
• Report on poor care
  • To the NYS Senior Medicare Patrol (SMP) or Beneficiary Family Centered Care Quality Improvement Organization (BFCC-QIO)

The NYS Senior Medicare Patrol can help all seniors with questions, concerns or complaints about Nursing Home Fraud, abuse and quality of care issues. Its certified counselors are available to help. Call 800-333-4374

"We have trained counselors to help educate Medicare beneficiaries in the fight against health care fraud. To report Medicare fraud, errors or abuse you can call our NYS Medicare Fraud Helpline at 800-333-4374 or visit www.nysenior.org," Alvarez concluded.

StateWide also provides information and educational presentations, assistance regarding any Medicare questions, plan comparisons, appeals, billing issues and patients' rights to all seniors throughout New York State.

It is estimated that Medicare fraud costs taxpayers over $60 billion dollars nationally per year. To help combat this illicit industry StateWide announced its Fraud of the Month program in 2022 to highlight these scams being perpetrated on the State's seniors.

SOURCE New York StateWide Senior Action Council, Inc.