MEDICARE FRAUD AND SCAMS
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1 MEDICARE FRAUD AND SCAMS Prevent, Detect and Report Healthcare Fraud and Scams Presented by: Madhavi Bhadbhade, Director Senior Medicare Patrol Program
2 What is Senior Medicare Patrol (SMP)? Help Medicare and Medicaid beneficiaries prevent, detect and report health care fraud Protect older persons from being victims of fraud and scams and help preserve the integrity of the Medicare and Medicaid programs Rely on volunteers to help perform SMP work
3 Examples of Fraud Schemes Billing for services, supplies or equipment that were not provided Obtaining Medicare number for free services Improper coding to obtain a higher payment Using another person s Medicare card to obtain medical care, supplies or equipment
4 Medicare Fraud Schemes Kickbacks, kickbacks, kickbacks Home Health Care Fraud Scooter Scams Arthritis Kit Scams Ambulance Rides Free Tests and Screenings Diabetic Supplies
5 Fraud Categories Physician fraud schemes DME fraud schemes Hospice fraud Hospital fraud Ambulance fraud Home Health fraud Prescription drug fraud
6 Three Steps to Prevent Healthcare Fraud Protect Detect Report
7 Step 1: Protect Yourself from Medicare Fraud & Abuse Do -Do Treat your Medicare card and number like your credit card -Do watch out for identity theft -Do be aware that Medicare doesn t call or visit to sell you anything Don t -Don t give out your Medicare number except to your doctor or other Medicare provider -Don t carry your Medicare card unless you will need it
8 Step 2: Detect Medicare Fraud & Abuse Review Medicare Summary Notices (MSNs) and other statements for: -Services you didn t receive -Double billing -Services not ordered by your doctor
9 Step 2: Detect Medicare Fraud & Abuse, continued Access your Medicare information online at -View most recent MSNs mailed quarterly -Check Part B deductive status -View eligibility information -Track available preventative services -Find Medicare health or prescription drug plans during annual enrollment period
10 Step 2: Detect Medicare Fraud & Abuse, continued Use your Personal Health Care Journal -Record doctor visits, tests, and procedures in this journal, and take it with you to your appointments Compare your MSNs and other statements to your journal to make sure they are correct
11 Step 3: Report Suspected Medicare Fraud and Abuse Call the provider first Gather information and documentation Contact Senior Medicare Patrol -This is a free and confidential service
12 SMP Case Investigation SMP staff refer Medicare cases received to the Office of Inspector General through the Administration for Community Living in HHS for investigation Medicaid cases are referred to Program Integrity Unit in DHHS or the Medicare Fraud Control Unit in the Attorney General s Office
13 Medicare Case Investigations HHS/ACL and OIG work with Medicare contractors, FBI and other agencies to investigate and resolve cases Medicaid fraud cases are investigated and resolved by the Medicaid Fraud Control Unit in Attorney General s Office working with the Program Integrity Unit in Nebraska DHHS
14 Common Scams in Nebraska Offers of New Medicare Card Diabetic Supplies Scams Soliciting bank information and Medicare/Social Security numbers Lottery and Sweepstakes Grandparent Scam Health Care Reform-related Scams Home Repair Scams Investment Schemes
15 Coordination at National Level to Address Scams SMP staff enter scams in SMP database National SMP collaborates with the Federal Trade Commission (FTC) and Consumer Financial Protection Bureau (CFPB) FTC and CFPB develop resources and outreach materials for use by agencies, financial institutions
16 Collaboration at State Level to Combat Frauds and Scams SMP collaborates with the Better Business Bureau, Senior Anti Fraud Education Program in the Attorney General s Office and TRIAD a volunteer group in Lincoln that does outreach to educate seniors about elder abuse and scams Joint presentations, shred events, joint press releases
17 SMP Volunteers Would you like to: -Help Medicare and Medicaid beneficiaries protect, detect and report fraud? -Educate seniors about prevalent scams? Join the SMP program as a volunteer!
18 Useful Resources Financial Exploitation by Family Members
19 Useful Resources Financial Exploitation by Strangers
20 Useful Resources Financial Exploitation - Contact us for copies of these placemats
21 New Resource Senate Aging Committee New Anti-Fraud Hotline to Assist Seniors Report suspected fraud by calling Visit new website,
22 Contact Us Visit us online at: Call toll-free
23 Thank You!
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