Something’s not right: Senior points out Medicare overbilling by Houston firm

Concerns Over Medicare Fraud in Montgomery County

In Montgomery County, Texas, Mike Berger has taken it upon himself to frequently check his Medicare notifications. He wants to ensure that the charges align with his medical records and doctor visits. However, he has recently noticed unfamiliar charges from health care providers, prompting him to reach out to Medicare about potential fraud.

“I really want to know what’s going on with my money. In my opinion, Medicare is my money,” Berger expressed. He believes that by the time the Medicare summary notices are accessible, payments for services, which he never actually received, have already been processed.

“It’s just not right. I don’t like things that aren’t right,” he continued. Last year, he identified at least two companies billing Medicare for services he had no record of receiving. One of these companies has a billing address in Houston.

Records indicate that the firm charged him for a new patient visit last June, raising a pressing question for Berger: “By the way, how did they get my Medicare number? I don’t know.”

Another local resident, Rich Cutler, faced similar challenges with the same Houston company, which had also billed him for nonexistent services since June.

Cutler mentioned, “I believe they provided a service to remotely track my biometrics and billed Medicare for that service.” The charges, while not exorbitant—less than $500 each—compound the issue, as Medicare and supplemental insurance had already settled claims by the time they’re visible in summary notices.

“The water is already over the dam. Now I have to get a teaspoon and push the water back into the dam. It’s frustrating, but I won’t quit,” Berger remarked, emphasizing the challenge of addressing the situation.

Investigations into Medicare billing issues were sparked back in November when reports surfaced about Sunshine Senior Solutions based in Florida. Seniors indicated that their Medicare accounts were being charged for medical supplies they never received.

In late October, investigators reached out to the Centers for Medicare and Medicaid Services (CMS) to learn about the number of complaints against Sunshine Senior Solutions. Two weeks later, a similar complaint was filed against the Houston company to gauge how widespread the issue might be across the U.S.

After following up in late January, investigators learned that while there was some response regarding Sunshine Senior Solutions, CMS stated they could not disclose specific information. Queries about the Houston company also fell under similar restrictions, with CMS indicating that fraud investigations involve complex procedures and interagency cooperation.

Berger expressed suspicion, suggesting that officials were perhaps hesitating to provide clarity on the situation. In November, CMS confirmed that Sunshine Senior Solutions wasn’t participating in the Medicare program, but they remained tight-lipped about the Houston company.

Interestingly, recent investigations found that the Houston company still had 17 providers listed in Medicare’s database, though they have since been removed following inquiries.

Cutler voiced concerns about accountability, asking, “How do we fight back against them? That’s what bothers me. And is someone actually going to pay for it?” Investigators attempted to locate the Houston company at its listed address but found an empty office space, with neighbors unable to recall any details about the previous occupants. Additionally, all associated phone numbers were disconnected.