LAS VEGAS (KTNV) — When the couple received nearly identical medical bills, their questions revealed what appears to be a larger issue around Medicare fraud.
Their discovery of duplicate charges led them down a rabbit hole of potential healthcare deception that could be costing taxpayers millions. So they asked Darcy, What's the Deal?
WATCH: Las Vegas patients, doctors caught up in nationwide fraudulent Medicare scheme
Kathy Clowers was doing her usual mail routine when she says her Medicare summary stopped her cold.
"This one got my attention because the amount was so high and I hadn't been sick," Kathy told me. "I never get sick."
Over $3,700 charged by a local doctor for wrist braces that she didn't need and says she never ordered.
"It says I hurt my elbow and my wrist and it was for durable medical equipment and I thought I didn't do that. And then, I was like well, let me get the calendar out and look. No. Didn't do anything back in November of last year and I thought they've made a mistake."
But then, she found her husband John's Medicare summary, showing nearly identical charges from the same company: "American Integrity Medica" in Houston, Texas. The listed address? A suite in a warehouse building owned by a man in Santa Monica, California.
While the Medicare statements say "American Integrity Medica", the business website and the Texas business license list them as "American Integrity Medical Supply". Although some bills say Medica, with the L at the end, there's no documented company with that name that we could find.
We reached out multiple times to American Integrity Medical, via phone and email. Our calls were not returned but we did get an email response early Tuesday morning saying, "we will pass along all the details and arrange the call." There was no name or other contact information on the email and we haven't heard back from them since.
"I called Medicare the next day and told them, hey, something's wrong. This is fraud," Kathy said. "They said thanks for calling because we have it over for review right now. We haven't paid out yet but thank you for letting us know."
Kathy's claims were approved but John's weren't. When Kathy posted about what happened on Nextdoor, she discovered they weren't alone.
"There were several people with the same problem and I went uh oh. This is big."
The posts tell the story:
"Everyone read your Medicare summaries," one post reads. "I just got charged $3,765 for equipment I never ordered from American Integrity Medica."
Another one reads "I found charges this morning also from American Integrity Medical."
Both names appeared, again with different spellings, prompting the same confusion and fraud concerns as the Clowers had. Complaints are also popping up nationwide on the Better Business Bureau's scam tracker.
Here's the twist. The doctors listed on the bills are real and they're local. We found them at Alpine Healthcare near Vegas Valley Drive and South Maryland Parkway. The clinic's lead physician confirmed that neither doctor has ever seen the Clowers or ordered any equipment for them.
He also told us that while he isn't familiar with the Texas company, their clinic did receive a letter about fraudulent lab orders last year. He believes someone stole patient insurance information and doctors' Medicare numbers to file bogus claims, which may explain a letter that John got in the spring.
"They changed my Medicare card and we thought that was real odd," John said. "That was what? A month ago."
"In April, you got a new Medicare number," Kathy said.
"So that just kind of came out of nowhere," I asked.
"Yeah," John said. "We had no idea."
Medicare told us just because something shows "payable" on your Medicare summary doesn't mean money will actually be paid, especially if a provider is under investigation.
It seems this provider was firmly on the feds' radar. Just as we were wrapping up our investigation, a Medicare spokesperson told us that American Integrity Medical's Medicare enrollment has been revoked.
Federal law shows that can happy for a variety of reasons like bad conduct, providing false or misleading information, or misusing and abusing billing numbers and privileges."
Medicare is trying to spread the word with ads like this.
So how do you report suspicious Medicare charges?
You can call Medicare directly at 1-800-633-4227 or you can report online by clicking on this link.
If you have a Medicare Advantage Plan or Medicare drug plan, you can also call the Investigations Medicare Drug Integrity Contractor (I-MEDIC) at 1-877-772-3379.
You will need the following information when you file a complaint.
- Name and contact information of the individual or business related to your complaint. That includes addresses, telephone numbers, email addresses, etc.
- An explanation that details the nature, scope, time frame and how you learned about the activity in question.
- Name and contact information of any individual who can help corroborate the information that you are reporting.
- Supporting evidence that you can submit electronically with your report. That can include email communications, documents, billing records or photographs.
Medicare officials say they review every complaint to see if further investigation is needed.
You can also report any suspected fraud to the Better Business Bureau Scam Tracker and check their database to see if others have reported the same business.
What should I look out for?
Medicare says you should check receipts and statements from providers for mistakes and call your provider's office if you think a charge is incorrect.
You can create a secure Medicare.gov account to view your Original Medicare claims as soon as they're processed to help spot mistakes sooner.
Medicare will never call you to sell you anything or visit you at your home. Medicare, or someone representing Medicare, will only call and ask for personal information in limited situations (like an agent or representative returning your call after you've joined a plan, reported fraud, or left a message for Medicare).
Don't give your Medicare card, Medicare number, Social Security card, or Social Security Number to anyone except your doctor or people you know should have it (like insurers acting on your behalf or people who work with Medicare, like your State Health Insurance Assistance Program (SHIP).
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