DRIPPING SPRINGS, Texas (KXAN) — Richard McGinn recalls the first package of COVID-19 tests he received in the mail in April.
He said he was puzzled since he had never ordered the tests or requested them.
“We get them in continuous days, and it went on for about four or five weeks,” McGinn explained.
He said that something didn’t seem right, so he started saving the tests. He’s collected more than 50 boxes of at-home COVID-19 tests.
“It was from places in California and Wisconsin and Florida. Different laboratories were sending them to us,” McGinn said “It just felt wrong.”
In Austin, Suzann Madeley opened a big tan bag where she stored all the tests she had received. Some she said that had arrived already expired.
“Here I am sitting with all of these that could have been used by someone and it makes me furious,” Madeley said. “It makes me furious. It’s so needless… It’s very frustrating!”
Cost to taxpayers
What troubled McGinn and Madeley was that Medicare was paying for the COVID tests.
McGinn showed KXAN investigators a statement he received in March where Medicare had been billed $200 for a box of tests. The amount paid by Medicare was $94.08. McGinn didn’t owe anything.
Madeley has gotten several Medicare statements showing similar charges. She shared a statement also from March where Medicare was billed $120 and paid $94.08.
“None of this has cost me a penny, but it’s been costing the taxpayers a lot of money,” Madeley said. “It’s wrong.”
The Centers for Medicare & Medicaid Services (CMS) said starting April 2022 through the end of the COVID-19 public health emergency, which ended May 11, 2023, Medicare covered and paid for up to eight over-the-counter COVID-19 tests each calendar month at no cost.
“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,” a CMS spokesperson said.
The spokesperson added CMS has received calls from Medicare beneficiaries who reported receiving tests they did not order or did not intend to automatically refill.
“The number of complaints represents a small portion of people with Medicare who have received these tests. CMS continues to look into the complaints we have received and are investigating instances of potential abuse,” the spokesperson said.
KXAN has requested the number of complaints received by the agency, but that data has not been provided yet.
‘First-of-their-kind’ charges
The spokesperson also said that CMS is working closely with law enforcement to investigate health care fraud schemes.
In April, 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.
An indictment obtained by KXAN investigators shows charges were filed against two people in Florida for allegedly unlawfully purchasing Medicare beneficiary identification numbers and shipping over-the-counter tests to them, in some instances, deceased patients, nationwide who did not request the tests. The DOJ called it a “first-of-their-kind charges” in a press release and said it caused over $8.4 million in fraudulent claims to Medicare.
Attorney Gilbert Schaffnit, who represents one of the people indicted, said the evidence will show that his client, who is a doctor, did not obtain Medicare information and provide it to anybody.
“There were third-party vendors that inexplicably are not charged with obtaining the information because they obtained it,” Schaffnit said. “They had to have somebody under whose billing number the compensation could be made.”
He added that his client is a victim because someone was using her provider number for the alleged fraud.
“She didn’t do anything wrong and hopefully she’ll be exonerated and be able to go back to practicing medicine. Let me put it this way, you know, the community would be better served if she were still able to practice,” Schaffnit said.
A lawyer for the other person indicted said they do not comment on ongoing cases.
‘Somebody’s got my Medicare information’
Madeley started calling the labs and warehouses sending her the tests but explained she was never able to connect with anyone.
“I didn’t want them. I didn’t order them. I don’t know why I was getting them,” Madeley said.
She added she’s been reporting every shipment to Medicare.
“I feel like somebody’s got my Medicare information, like identity theft, essentially. I mean, it doesn’t involve checks — it doesn’t involve credit cards — but it does involve my identity and my Medicare number,” she said. “It is concerning.”
KXAN investigators have reached out to the labs and warehouses sending Central Texans the unwanted and expired COVID-19 tests but have not heard back.
CMS explained the expiration date of some tests has been extended by the Food and Drug Administration.
“Individuals can submit information about expired tests in the same way that they have been reporting that they’ve received unsolicited, at-home, COVID tests, as expired tests could also be considered fraud,” the spokesperson said.
Guard and report
CMS said everyone should guard their Medicare number like their Social Security and credit cards and only share it with trusted health care providers.
The agency said people with Medicare who receive COVID-19 tests 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 tests, they should contact their pharmacy/provider to opt out and stop refills.
Consumers with any type of insurance can report suspected fraud by contacting the Health & Human Services fraud hotline at: 1-800-447-8477 (1-800-HHS-Tips).
If anyone suspects COVID-19 health care fraud they should report it immediately online or call 1-800-HHS-TIPS (1-800-447-8477).
Investigative Photojournalist Richie Bowes, Photojournalist Ed Zavala, Graphic Artist Christina Staggs and Director of Investigations & Innovation Josh Hinkle contributed to this report.
