Check your Medicare statement carefully

If a poll were to be taken, I would have to be the last person on this planet who thinks that government is a perfect institution. I respect the FBI and the CIA, and I even trust the IRS. As a senior citizen, I have always considered Medicare one of the finest agencies we have, but some new facts have emerged that have convinced me that it is a sloppy and careless government behemoth.

My loss of faith in the folks who run Medicare started about three months ago, when I opened up my wife, Suzan’s, periodic statements of money spent on her medical needs. I quickly noticed that Medicare had approved $14,300 for a Texas company named Pretty in Pink Boutique. There was a claim for the sale of 600 urinary catheters over a 60-day period to my wife.

I’m happy that Suzan is physically well and by no means has any need for a warehouse full of catheters. Within minutes of discovering that Medicare had approved and paid for all of them, I placed a call to the agency’s general number. I was connected to a woman named Gladys, who listened patiently to my complaint and, at my request, I was transferred to a Fraud Unit.

The person there noted my complaint, and assured me that it would be passed up the bureaucratic chain, to make sure there was a record of the payment, which was obviously fraudulent. A few days, later I received my periodic Medicare statement, and immediately noticed that Medicare had paid a company in Chicago for a coronavirus vaccine that I had allegedly received. That seemed strange, because I had gotten my shot at a local pharmacy, not connected to any company in Illinois.

Not to be deterred, I placed another call to the Medicare Fraud Unit, and they dutifully noted my concern about another improper payment for medical services. Satisfied that I had performed my civic duty, I turned my attention back to my law practice and other pursuits. My satisfaction lasted about 48 hours, until I spotted a New York Times article titled “Staggering Rise in Catheter Bills Suggests Medicare Scam.”

It seems that a woman named Linda Hennis, a resident of suburban Chicago, was checking her January Medicare statement when she noticed that a company she had never heard of had been paid about $12,000 for 2,000 catheters. She had never needed, or received, any catheters. They had been sold by a company called, guess what, Pretty in Pink Boutique.

It seems that Ms. Hennis and my wife are among the 450,000 Medicare beneficiaries whose accounts were billed for catheters in 2023, up from 50,000 in previous years. It turns out that the massive increase in billing for catheters included $2 billion charged by seven high-volume suppliers, which was the equivalent of nearly one-fifth of all Medicare spending on supplies in 2023. Doctors, state insurance departments and health care groups around the country said this spike in claims for catheters that were never delivered suggests that it is not only a scam, but a far-reaching one.

What is the government doing? Dara Corrigan, who runs Medicare’s Center for Program Integrity, declined to say whether the agency was investigating the catheter billings. She would not confirm whether the claims had been paid. She described Medicare billing scams as “one of these problems that is ever-present and ever frustrating.”

It turns out that Pretty in Pink Boutique billed Medicare at least $267 million for catheters between October 2022 and December 2023. The vast majority of the suspicious claims came from seven companies, many of which had shared executives. One of the businesses had a working phone number, but no calls were returned. The Pretty in Pink Boutique has a telephone number connected to a body shop.

Other scams are getting public attention, such as phony Covid vaccine claims, which are slowly surfacing. Regardless of its denials or bureaucratic double-speak, Medicare is failing the millions of Americans who rely on the system to be accurate and honest. Every dollar lost to some con artist is a dollar meant to pay for a legitimate health care claim.

Jerry Kremer was an Assemblyman for 23 years, and chaired the Assembly’s Ways and Means Committee for 12 years. He now heads Empire Government Strategies, a business development and legislative strategy firm. Comments about this column? jkremer@liherald.com.