MONTGOMERY COUNTY, Texas (KTRK) — Mike Berger said he always checks his Medicare notices to keep track of the claims on his account and make sure they line up with his medical records and doctor’s visits.
But last year, he said he started noticing charges on his account were for providers he didn’t recognize so he called Medicare to report fraud.
“I really want to know what’s happening with my money and Medicare is my money in my opinion,” said Berger, of Montgomery.
Berger said by the time he’s able to view his Medicare Summary Notice, the provider has already been paid by Medicare for services he never received.
“It just – it ain’t right and I don’t like things that aren’t right,” Berger said.
In the last year, Berger says he has spotted at least two different companies charging his Medicare for services he never received.
One of the companies shows a Houston billing address, according to Medicare records.
Berger’s statements show the Houston company was billing him for a new patient visit as far back as June of last year.
“Now, how did they get my Medicare number? I don’t know,” Berger said.
ABC13 isn’t naming the company because Medicare would not confirm to 13 Investigates that they are looking into it.
Rich Cutler said he also has charges for services he never received from the same Houston company.
Medicare notices for Cutler, who also lives in Montgomery County, show the company started charging him as far back as June as well.
“They were supposedly providing services to track my biometrics remotely and charging Medicare for those services,” Cutler said.
The charges for both men aren’t considered large as far as medical billing goes, at less than $500 each time.
But by the time they are able to see the charges on their summary notices, Medicare and their supplemental insurance have already paid out the claims.
“It is already water over the dam. Now I got to get a teaspoon and get the water back over the dam. It’s frustrating, but I won’t stop,” Berger said.
13 Investigates first started investigating concerns with Medicare billing in November, when we reported on Florida-based Sunshine Senior Solutions.
The seniors we spoke with back then told us Sunshine Senior Solutions billed their Medicare accounts for medical supplies and items they didn’t need.
“I would know if I had a catheter,” Ron Barlow told 13 Investigates last year.
RELATED: ‘I would know if I had a catheter’: Man surprised by Medicare charges
At the end of last October, which was six weeks before that story aired, 13 Investigates requested the number of complaints they received regarding Sunshine Senior Solutions from the Centers for Medicare and Medicaid Services.
Two weeks later, we put in the same request for complaints against the Houston-based company. We wanted to know how widespread the issue was across the U.S.
Since we started following up with CMS on this story in late January, we finally got an answer on Sunshine Senior Solutions, with the federal government saying they will not release the information.
The completion date for our request about complaints on the Houston company is listed as “undetermined,” in Medicare’s open records system.
We wanted to know the reason for the delays.
CMS told 13 Investigates that fraud investigations are complex and require extensive fact-finding, legal review, and coordination across agencies.
They also said the length of an investigation can vary based on a number of factors to ensure actions taken by CMS and partner agencies are thorough, legally sound and durable.
“You think they could tie it together somehow and tell me that, ‘yes, they’re working on it’ or ‘no, we’ve determined it’s not going there,'” Berger said.
In November, CMS confirmed to 13 Investigates that Sunshine Senior Solutions was no longer enrolled in the Medicare program.
But when we asked about the Houston company, CMS said it “is unable to comment on specific companies’ enrollment details, complaint volumes, referrals, or potential ongoing investigative activity.”
As recently as last week, 13 Investigates found the company still had 17 providers listed in Medicare’s provider database, but since we started asking questions, they were removed.
“How do you go back against them? That’s what bothers me. And is somebody going to actually pay the price for it?” Cutler said.
13 Investigates tried to track down the Houston company by stopping by the address they provided to Medicare, but it was an empty office suite. Neighbors of that suite told us someone had just moved out, but they didn’t recall who it was.
All of the phone numbers associated with the business were disconnected.
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