Medicare Fraud on the Rise: Tennessee Residents Targeted

A growing number of Medicare recipients in Tennessee are falling victim to fraudulent schemes, including unnecessary genetic testing and unsolicited medical equipment. A recent case involving a Nashville couple highlights the increasing prevalence of this issue and the potential financial burden it places on beneficiaries.

The Leins’ Experience: A Case Study in Medicare Fraud

Doug Leins and his wife, residents of West Nashville, were recently billed through their Medicare supplemental insurance for genetic testing they never requested or authorized. As reported by WSMV4, the couple’s doctor also did not order the tests. Adding to their concerns, they received unsolicited knee and back braces in the mail, for which they had not placed an order.

The fraudulent genetic testing charges appeared on their Explanation of Benefits statements, with identical charges originating from two separate clinical laboratories – one in Arizona and one in Utah. Notably, neither laboratory had a working phone number when the Leins attempted to contact them. The couple faces a potential out-of-pocket charge of $1,329 related to the fraudulent testing.

How Medicare Fraud Impacts Beneficiaries

Fraudulent charges submitted to Medicare supplemental insurance can reduce the amount of coverage available for legitimate medical services throughout the year. Because Medicare typically bills before supplemental insurance, fraudulent claims can quickly deplete annual coverage limits. This leaves beneficiaries responsible for a larger share of their healthcare costs.

A Broader Pattern of Fraud in Middle Tennessee

The Leins’ case is not isolated. WSMV4 Investigates has been reporting on a broader pattern of Medicare fraud in Middle Tennessee. This includes instances of individuals being billed for medical equipment they did not order or need.

Russian Connection to Tennessee Medicare Billing Scheme

Recent investigations have uncovered a potential link between the fraudulent billing and a Russian citizen living in Texas who has been federally indicted in a Medicare fraud scheme. WSMV4’s investigation revealed that Medicare was billed tens of thousands of dollars for Tennessee recipients who never received the billed services. The investigation also found that the Russian citizen, Nika Machutadze, faces federal charges for the fraud scheme.

What to Do If You Suspect Medicare Fraud

Tennessee Medicare recipients identified in this investigation, and anyone who suspects they have been a victim of Medicare fraud, are encouraged to contact Medicare to obtain recent Medicare ID numbers due to the potential for data breaches. The Leins have already reported the fraudulent charges to their Medicare supplemental insurance provider and are awaiting their quarterly Medicare report to determine if Medicare also paid out for the genetic testing.

Protecting Your Medicare Information

Data breaches are often the primary way Medicare ID numbers fall into the hands of criminals. It’s crucial to protect your Medicare card like a credit card and be vigilant about reviewing your Explanation of Benefits statements for any suspicious charges.