Care facility possibly inflating Medicare claims: Is it worth the bother reporting?

@Cover999 you can request to see progress notes and medical information.
" With limited exceptions, the HIPAA Privacy Rule (the Privacy Rule) provides individuals with a legal, enforceable right to see and receive copies upon request of the information in their medical and other health records maintained by their health care providers and health plans".

What the hospital charged and what they received from Medicare are different things. The hospital charges 1000, Medicare's reasonable amount is 600 then they only pay 80% of that. Which is 480. So patient owes 120. Hopefully that is paid by the supplimental. Patient can't pay more than the reasonable amount of 600. The provider has to except the reasonable amount.

Good thread Thank you. Ironically I was tossing out my mom's Medicare statements from the hospital, NH, etc. The GI doc submitted claims even though his services were no longer needed since tube feeding had been discontinued, He submitted claims (that were paid) up until the day she was taken off life support.

Hospital made some nice money on her sickness and as you will see from her notices these places charge for everything.

If you think there is fraud report it.
A few comments though.
That therapist and the 10 minute call. The call may be 10 minutes but a review of the chart, documenting the call are unseen minutes that the therapist spends for your moms "visit".
PT and or OT surprised me when my Husband was in rehab. I would try to get there so I could observe the Therapy they were doing. Several times I arrived and was told that they were done. The "therapy" was him getting dressed, I guess that qualifies as OT. They may even consider her getting her own lunch or coloring as "active PT"
But you should be able to review the PT and OT notes for the days that you are questioning.

When I had cervical spine surgery in 2008 with a major insurance carrier paying for my care, I was in the hospital for 24 hours. The cost for my stay was well over $250,000.00. The insurance company asked that we all report suspect claims to them immediately for investigation, to help keep all of our premiums lower, and blah blah. Which is exactly what I did. Only to be laughed at (literally) on the phone by the claims investigator I spoke with! She said that was the going rate for care, and not out of line at all. Needless to say, that was the LAST time I wasted MY time reporting what I felt to be overinflated costs to insurance companies.

With Medicare, the costs have to be billed at exorbitant amounts just so the providers can get SOMETHING for the services, since Medicare pays a tiny fraction of what's billed.

I wouldn't touch this with a ten foot pole if it were me, based on my past history. Plus, you'll be on the phone for GOD knows how long, jumping through who knows how many fiery hoops, all for what? If Medicare wants us to report suspicious activity to them, then they should send us a FORM to fill out and return in the mail. Would make life a whole lot easier for all concerned. Then they can throw it in File 13 and that's that.

It is always worth reporting a claim. I hate what nursing homes are allowed to get away with. The blantant thieving and ripping off families disgusts me to my very core. It makes me sick how they can just devastate a family's finances while at the same time collecting payment from the government (Medicare/Medicaid) for services they didn'e even render.
It's always worth it. It's worth it if they've charged 25 cents over what they're owed.
When my parent was in the nursing home, I scrutinized every bill and statement. Turns out they were not only frauding Medicare, but also us. They got in trouble with Medicare and had to pay back. They also had to refund some money to the estate. This brought me such satisfaction. It's always worth the effort.