Brandenburg and other UnityPoint Health-Marshalltown volunteers are Senior Health Insurance Information Specialists. Their job is to counsel local Medicare recipients about Medicare insurance plan options.

Their services are free, confidential and objective. One year they saved recipients $733,000.

And they don’t want to see any of that money end up in the pockets of unscrupulous Medicare fraud-masters.

For example, Brandenburg said some companies have been promoting a “free” genetic (or DNA) test to screen for cancer to Medicare recipients. The individual is asked to swab their cheek to collect a DNA sample to send to a lab for analysis.

T-R PHOTO BY MIKE DONAHEY
UnityPoint Health-Marshalltown Senior Health Insurance Information Program volunteer Bobbi Brandenburg of Albion reviews Medicare fraud alerts Friday at the Times-Republican.

Recipients are incorrectly told Medicare covers the cost of this test. People are approached at community events, senior centers, health fairs and housing complexes. Other people receive telephone calls. They are told they will receive a free DNA test kit and to return it with their swab.

Often unsuspecting Medicare recipients are asked for personal health information, such as height, weight, family history of cancer and so on.

“In all of these situations individuals are told the cost of the test will be covered completely by Medicare and all that is needed to proceed is the person’s Medicare number,” Brandenburg said. “The only test Medicare covers is a colorectal cancer screening test — Cologuard — ordered by one’s physician.”

Concerning genetic testing, Brandenburg said Medicare only pays for DNA or genetic testing in limited circumstances where it is medically necessary for diagnosis or treatment of medical conditions. There must be documentation in one’s medical record to substantiate the need for testing.

The Associated Press recently reported on an Omaha man who defrauded Medicare and Medicaid in a scheme involving recipients in Nebraska, Iowa and other states.

A U.S. District Court complaint filed earlier this month says Nereus Sutko committed health care fraud that began in November 2010 and continued into this month. Sutko’s attorney, Adam Sipple, said Monday that Sutko will plead not guilty.

The documents say Sutko sometimes visited homeless shelters and threw pizza parties at nursing homes, promising gifts as a way to obtain Social Security and health information for his scheme. The documents say Sutko would order health care items that would never be delivered to the recipients.

Sutko is alleged to have filed 1,666 Medicare claims through the company he managed, Better Lives, getting more than $674,000. Assistant U.S. Attorney Mike Norris says he can’t yet specify how much money Sutko is alleged to have fraudulently profited through his scheme.

Brandenburg said the best way to prevent being a victim of Medicare fraud is to make sure one’s doctor has assessed one’s condition.

“And treat your Medicare number like your Social Security number,” she said. “Do not give out over the telephone to telemarketers or at senior fairs,” she said.

For more information contact Brandenburg at 641-754-5399.