OCALA, Fla. — Residents across the area are getting COVID-19 tests that suddenly show up at their homes.
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In recent weeks, several people have reached out to Channel 9 for help. Our investigation lead us to Ocala, where Sharon Breitenbecker said she signed up for the free at-home COVID tests more than a year ago.
Back then, a few tests showed up, but then the shipments stopped. Now, she’s suddenly getting more than she knows what to do with and has two dozen test kits.
“First once a month and now once a week. It’s crazy,” Brietenbecker said.
The day Channel 9 went to Breitenbecker’s home, she had just received yet another shipment, giving her a total of 26. On the return address, it says the package of covid tests are from “N-J warehouse.”
We opened it and found the entire batch was expired.
Breitenbecker said she was too afraid to call.
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“I don’t want them to have my home phone, my cellphone number, my email or anything.”
So, Channel 9 called. While the package read New Jersey, the phone number went to California. But it didn’t matter, because after multiple times trying to reach someone, we kept getting a voicemail.
Medicare advocates who track fraud noticed an eleventh-hour rise in complaints from beneficiaries who received tests they never requested.
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It’s a signal that someone may have been using Medicare information, possibly through a data breach, to improperly billing the federal government and likely make millions, with the U.S. Department of Health and Human Services warning: “scammers can bill federal health care programs or commit medical identity theft.”
If Medicare or Medicaid denies the claim for unapproved tests, you could be responsible for the cost.
That’s the concern for the seniors who called us asking for our help.
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“I don’t know whose paying for it, us taxpayers? The government should look into it too, to see what i going on,” Breitenbecker said.
For its part, the feds are trying to stop this. Scott Lampert, the assistant inspector general for investigations, said that the tests are coming from labs all across the country. in April, the Department of Justice charged 18 people with COVID-related fraud, including two in Florida. They’re accused of buying Medicare numbers and submitting more than $8 million dollars for COVID tests. But the feds concede that there are still more people out there
the FDA cautions to only use approved tests, and many of these are not. Advocates say if you didn’t order the test, it’s probably best to throw it out.
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So, what do you do if you receive unwanted covid tests? You should report it to visit medicare.gov.
Even so, your explanation of benefits from Medicare will show the name of the lab that was paid for your tests. File a complaint against that company with the BBB, and call that company to ask that they stop sending you tests if you can get a hold of them.
You can also use the HHS-OIG hotline by visiting tips.HHS.gov or call 1-800-HHS-TIPS.
For Phil Hambrecht, he contacted Channel 9 saying he spent 20 minutes on the phone with Medicare trying to get to the bottom of why he was receiving all of those tests and wanted to know what he was being charged.
He said someone on the other line looked at the bill and found out that, since November, his wife’s account was charged $24 per test. In all, he was billed $864 for COVID-19 tests he never wanted.
AN FOR PHIL HAMBRECHT, HE CONTACTED US TELLING US THAT HE SPENT 20 MINUTES ON THE PHONE WITH MEDICARE TRYING TO GET TO THE BOTTOM OF WHY HE WAS GETTING ALL OF THESE TESTS AND WANTED TO KNOW WHAT HE WAS BEING CHARGED.
“She went back to November of 2022 and there was nine charges and none of them had been approved up to that point,” Hambrecht said. “She said, ‘Well, I got to approve them. I said, ‘What do you mean I got to approve them? I didn’t ask for these.’ She said, “Well, I got to approve them because they sent us the bill and we just do it anyway. There is no checks and balances on their end.”
Medicare said it is investigating any case of possible abuse, writing, “While CMS has received … the number of complaints represent a small portion of people with Medicare that have received these tests. We also required that patients must request them, although we did not prohibit participating pharmacies and health care providers from automatically refilling them each month.”
Read Medicaid’s full statement below:
COVID-19 testing is a critical part of the COVID-19 pandemic response. CMS implemented the over-the-counter (OTC) COVID-19 Test Demonstration to test the efficacy of Medicare covering over-the-counter COVID-19 tests without cost-sharing during the COVID-19 public health emergency (PHE). This demonstration was consistent with the Biden-Harris Administration’s overall strategy to ramp-up access to easy-to-use, at-home COVID-19 tests free of charge during the PHE.
Starting April 4, 2022 and through the end of the COVID-19 PHE, which ended May 11, 2023, Medicare covered and paid for up to eight OTC COVID-19 tests each calendar month at no cost to people with Medicare Part B. This includes people with Medicare Part B through Original Medicare and those enrolled in Medicare Advantage (MA) plans. Under the demonstration, Medicare paid participating pharmacies and providers up to $12 for each test kit.
As part of the demonstration, CMS included safeguards to mitigate the risk of abusive billing including limiting the number of test kits to eight per month. We also required that patients must request them, although we did not prohibit participating pharmacies and health care providers from automatically refilling them each month. CMS has advised pharmacies and health care providers participating in the COVID-19 Test Demonstration to keep documentation of these requests, as CMS may ask to see documentation showing a patient’s request for tests. If pharmacies/providers do not provide the documentation, CMS may recoup payment and may take other actions.
For additional information about the CMS OTC Test Demonstration, please see: https://www.cms.gov/files/document/over-counter-covid-19-test-demonstration.pdf.
CMS has received calls from some Medicare beneficiaries who reported receiving test kits they did not order or did not intend to automatically refill. While CMS has received complaints during the OTC COVID-19 test demonstration, the number of complaints represent a small portion of people with Medicare that have received these tests. CMS continues to look into the complaints we have received and are investigating instances of potential abuse of this demonstration.
CMS is working closely with our law enforcement partners to investigate health care fraud schemes that exploit the COVID-19 pandemic. This includes investigating instances of unsolicited test kits. On April 20th, 2023, The Department of Justice (DOJ) announced criminal charges against 18 defendants in nine federal districts across the United States for their alleged participation in various fraud schemes involving health care services that exploited the COVID-19 pandemic including shipping unsolicited COVID-19 tests. In connection with the enforcement action, the department seized over $16 million in cash and other fraud proceeds. CMS separately announced on April 20, 2023 that it took adverse administrative actions in the last year against 28 medical providers for their alleged involvement in COVID-19 schemes. A press release from DOJ on this subject can be found here: https://www.justice.gov/opa/pr/justice-department-announces-nationwide-coordinated-law-enforcement-action-combat-covid-19.
People with Medicare who receive COVID-19 test kits they did not order should call 1-800-MEDICARE (1-800-633-4227) and report it. If they did not intend to automatically refill or no longer want refills of the test kits, they should contact their pharmacy/provider to opt-out and stop refills.
The Department of Health and Human Services (HHS) Office of the Inspector General (OIG) has an alert regarding COVID-19 related scams, including unsolicited test kits, on their website: https://oig.hhs.gov/fraud/consumer-alerts/fraud-alert-covid-19-scams/
Our top tip is to guard your Medicare number just like your Social Security and credit cards. You should only share your Medicare number with trusted health care providers or verified COVID-19 vaccine administrators. For your reporting purposes, the following information may be helpful: https://www.cms.gov/About-CMS/Components/CPI/CPIReportingFraud.
Consumers with any type of insurance can report suspected fraud by contacting the Health & Human Services (HHS) fraud hotline at: 1-800-447-8477 (1-800-HHS-Tips). More information on reporting Medicare Fraud can be found at https://www.medicare.gov/forms-help-resources/help-fight-medicare-fraud.
If anyone suspects COVID-19 health care fraud they should report it immediately online at https://oig.hhs.gov/fraud/report-fraud/ or call 1-800-HHS-TIPS (1-800-447-8477)
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