Me on Monday & a Mystery

I am a victim of Medicare Fraud. Yes, you read that right. I have been the victim of Medicare fraud. 

Here’s the story:

When I received my most recent Medicare statement, I was looking at it--which I don't often do. Actually, I never really thought about it. I usually just file it away. Anyway, I happened to be looking at it and an outrageous charge caught my eye. 

It's a charge of $2,580---two THOUSAND five hundred and eighty dollars---for a dressing!! A dressing!! How is that possible? Then I looked closer. The doctor is in Florida with Sunshine Senior Solutions. Obviously something to do with old people. Location: Delray Beach, FL. I have NEVER been there or anywhere close to there. 

Then, I noticed that this charge has been recurring for 7 months. Every month! Now I knew that just wasn't right. I didn't have any statements before that because I clean out my files in January and toss the previous year's paperwork. So, I really have no idea how long this has been going on.

That's when I decided to call the fraud line. Here's how that went.

I was on hold for 9 minutes. I gave all the information about the “dressing” that I was charged for starting in August of 2024. I went through everything with this agent. The agent asked me about the charges for catheters over this same period. Catheters? That wasn’t even on my statement. I asked why I didn't have that information. She didn't know--that it would probably be on the next statement. So there were additional charges that were not included on my summary report. Now this makes me think that Medicare has no idea what’s going on! 

Finally she said that she needed to transfer me to another department to help me with the billing aspect. I told her that I have not paid anything. Then she said it was to protect me if I should ever need these dressings or catheters. Apparently since the fraud was discovered, that would make me ineligible for these items--should I need them in the future. Okay, fine. I don't really understand that, but fine. Moving on.

So I get another person who asks me questions and goes through everything all over again. I asked if she could see how far back it went. She couldn't. What? Were they not looking at my account! She did question my legitimate charge of $8,760 a month for my Xolair. All of a sudden, I got this sinking feeling that I might be messing myself up for that charge. Would they now take a closer look and think there's something amiss with this one? Yes, it's a lot. A. Lot. But, I have no control over that I and need this infusion every 5 weeks. 

Then, she proceeds to tell me what's going to happen. She said she had to read a paper to me. That seemed a little weird, but I said "okay!" There was so much information being thrown at me--I simply could not absorb it all. I asked her if she could just email it to me. She said it was just written on a paper to be read. What? Am I really talking to the fraud department? It seems so amateurish and lame. So, I asked her to read it again and I would take notes. 

Here are my notes in a nutshell:

A Unified Program Integrity Contractor would have one of these three companies contact me to set up an appointment to come to the house to interview me:

    Qlerent

    Covent Bridge

    Safeguard Services Unified

After the interview, I might have to appear in court to testify. 

The call lasted—44.31 minutes.

My first thought is why do they have to come in person to interview me? The whole thing sounds strange. I have so many questions like:

How did that doctor in FL get my Medicare info?

How does one get "picked" to be scammed?

Wouldn't Medicare question a recurring charge coming out of FL when I clearly live in TN?

It kind of sounds like Medicare has no idea what is going on. That make two of us! It's a mystery for sure.

PS And it's been over a week and I haven't heard anything. I guess they are in no hurry to shut down a charge of nearly $2600 a month! I did explain to the person I talked to that I have my phone set for any calls not in my contacts go straight to voicemail. They would need to leave me a message to call them back. We'll see. I let you know if anything comes of it.