Prevent Medicare fraud, scams and identity theft

Prevent Medicare fraud, scams and identity theft

Prevent Medicare fraud, scams and identity theft 1/28/20 Medicare fraud, errors and abuse affect Everyone Billions of taxpayer dollars lost to improper claims Medicare trust fund at risk Medicare beneficiaries

Higher premiums Quality of treatment Less money for needed benefits Prevent Medicare fraud, scams and identity theft 1/28/20 2 What is the Senior Medicare Patrol (SMP)? Prevent Medicare fraud, scams and identity theft

1/28/20 3 Volunteers matter! Prevent Medicare fraud, scams and identity theft 1/28/20 4 What is Medicare fraud?

Intentionally billing Medicare for services beneficiaries never received, or billing for a service at a higher rate than is actually justified. Prevent Medicare fraud, scams and identity theft 1/28/20 5 What is Medicare abuse? Providers who are supplying services or

products that are not medically necessary or that do not meet professional standards. Prevent Medicare fraud, scams and identity theft 1/28/20 6 Examples of fraud and abuse Prevent Medicare fraud, scams and identity theft

1/28/20 7 What about errors? Health care services and billing are complicated, which can lead to errors. Only a review and investigation of the issue will determine if it is an error, fraud or abuse. Prevent Medicare fraud, scams and identity theft 1/28/20

8 Consequences to consumers Prevent Medicare fraud, scams and identity theft 1/28/20 9 Consequences to perpetrators Its a federal crime to defraud the U.S.

government or any of its programs! Prevent Medicare fraud, scams and identity theft 1/28/20 10 Medical equipment fraud Owner of fraudulent medical equipment supplier Posed as employee of a legitimate supplier who

contracts with the nursing homes Gained access to several nursing homes Accessed medical charts Billed Medicare Stole medical information Prevent Medicare fraud, scams and identity theft 1/28/20 11

Prescription drug fraud Things to look for: Prescriptions for medications that are not medically necessary for the beneficiary. Beneficiaries seeking fraudulent prescriptions. Criminals acquiring Medicare and Medicaid numbers to bill for prescriptions the beneficiary never received. Prevent Medicare fraud, scams and identity theft 1/28/20

12 Who commits fraud, waste and abuse? Most providers are honest. Only 2-3% of providers bill fraudulently. Prevent Medicare fraud, scams and identity theft 1/28/20

13 Protect from Medicare fraud & abuse Prevent Medicare fraud, scams and identity theft 1/28/20 14 Protect from Medicare fraud & abuse Protecting a Medicare number helps prevent IDENTITY THEFT.

What else can clients do? DO not call list Shared private information Hang up on marketing calls Avoid clicking on links in email Prevent Medicare fraud, scams and identity theft 1/28/20 15 Medical identity theft

Prevent Medicare fraud, scams and identity theft 1/28/20 16 Detect Medicare fraud and abuse Tell clients to review Medicare Summary Notices (MSNs) and other statements for: 1. Services they didnt receive 2. Double-billing 3. Services not ordered by their doctor

Prevent Medicare fraud, scams and identity theft 1/28/20 17 Detect Medicare fraud and abuse Use the Personal Health Care Journal Record doctor visits, tests, and procedures in this journal.

Encourage clients to take it with them to appointments. Clients can ask themselves questions about their health care & write the answers down and other information in the journal.

Use the journal to compare their MSNs and other statements to make sure they are correct. Prevent Medicare fraud, scams and identity theft 1/28/20 18 Report suspected Medicare fraud & abuse Call the provider

Gather information and documentation. Check to see if there is a SMP sponsor in your area. Call 1-800 MEDICARE Prevent Medicare fraud, scams and identity theft 1/28/20 19

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