Nursing Home Fraud

Is New York StateWide Senior Action Council's Medicare Fraud of the Month for February

ALBANY, N.Y., Feb. 16, 2023 /PRNewswire/ -- New York StateWide Senior Action Council (StateWide), an organization dedicated to advocacy for the rights of seniors in New York State today announced its Medicare Fraud of the Month for February: Nursing Home Fraud.

The StateWide Fraud of the Month is a component of the Senior Medicare Patrol, the definitive resource for New York State's senior citizens 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) often located within a nursing home. Because of the complexity of SNF coverage, Medicare is often a target for fraud, errors and abuse," stated Maria Alvarez, Executive Director of StateWide.

She added, "There are many other ways nursing homes can perpetuate fraud so it is important for seniors, their families and caregivers to take extra precautions to prevent and spot these schemes."

How to Stop Nursing Home Fraud:

• Read the Medicare Summary Notice (MSN) or Explanation of Benefits (EOB) to compare the services Medicare was charged, with what was received.
• Check for double billing for services or treatments.
  
  
• Check for services that were not deemed medically necessary by doctors.
  
  
• Work with a doctor to enroll in any SNF therapy services you may need and to determine the medical necessity for these services.
  
  
• Do not accept gifts (such as money, gift cards, or groceries) in return for choosing a nursing home in which to receive skilled nursing.
  
  
• Do not sign forms that are not understood, including an Advance Beneficiary Notice (ABN), Medicare Outpatient Observation Notice (MOON), or any form that is blank.
  
  
• Report quality-of-care complaints to the Senior Medicare Patrol and the Beneficiary Family Centered Care Quality Improvement Organization (BFCC-QIO).

The NYS Senior Medicare Patrol has a hotline for people who believe they have been a victim of any Medicare fraud. Call 800-333-4374. Or visit nysenior.org. Certified counselors are ready to help answer any questions regarding Medicare benefits and issues.

It is estimated that Medicare fraud costs New York taxpayers over $5 billion dollars a 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.