Scam/News
Update from Cahaba Safeguard AdministratorsJune 26th, 2006
The administrator of a home health agency in our jurisdiction (located in California) called our office and shared an incident reported by the husband of one of the agency's patients. The administrator was informed that two weeks ago, a man wearing a suit showed up at the patient's doorstep claiming to be a "Physical Therapy Inspector for Medicare". The man had no identification or business cards, didn't ask for the patient's signature but did ask questions regarding the patient's physical status. Then Wednesday June 14th, around 9:00 PM, a man calle4d the patient's house and spoke with the patient's husband - ultimately setting up an appointment to come out the next morning and provide "free physical therapy". The patient's husband accepted the man's offer to come out the next morning. The man showed up, and was a different person than the one that had been to their residence before. He called himself a "Physical Therapy Trainer", said their doctor sent him, and knew the doctors name. He was not wearing a suit, but, like the first man, had no identification or business card. He helped the patient "walk around" then asked that she sign what appeared to be a preprinted check-box type of form as he needed a signature "to get paid". The patient's husband then notified the home health nurse, who in turn informed the administrator.
The incident was reported to the police, who were unable to do anything, as "no crime was committed". The administrator informed all of the agency's patients that someone was going around "knocking on doors" and reminded them that all of home health agency's employees have identification badges and stressed that the patients ask to see this badge before letting anyone in their homes. The administrator indicated she was having their badge security updated as well as also indicated she was going to inform the Center for Healthcare Rights.
The administrator confirmed with me that, if our company was out doing an audit, or if the OIG were talking to people, we would have identification and present it to the patients. I informed her that was correct, and that we would not misrepresent ourselves. I told her she had taken appropriate steps to inform her patients, and she added that she had a nurse inform her "a friend had said that this sort of thing had happened recently and a person's house had been ransacked".
The patients husband says they did not give out her Medicare number. In regards to Part A Medicare, the agency is already providing services in the home, so, under PPS rules, if another agency tried to bill for home health, the claim would deny.
We have a lot of CA cases pertaining to stolen or sold Medicare numbers and have lists of physicians and patients that are potentially suspect. I checked all of our lists and did not find the patient's Medicare number nor the doctors name. Any feedback you can give is appreciated. Thanks.
Melissa Murry - Investigator II
Medicare Benefit Integrity Unit
Cahaba Safeguard Administrators (CSA) - Midwest