How Do We Stop Medicare Fraud?

1. How Do We Stop Medicare Fraud? Senior Medicare Patrol (SMP) educates people to protect themselves from Medicare fraud, waste and abuse FRAUD Hot Line 855-613-7080

2. Why Do We Care? • Every year, Medicare loses billions of dollars • Fraud can be dangerous to your health! • You may be labeled an ‘over-utilizer’: • You may lose access to care and benefits • You may be unable to get needed equipment • All taxpayers lose

3. It’s Easier than Robbing a Bank! • Medicare pays first • and asks questions • Later (pay and chase) • -It’s like having an ATM • available anytime the • bad guys want money

4. MEDICARE PAID FOR LAMBORGHINIS - $55 MILLION IN FALSE MEDICARE CLAIMS

5. Some Common Schemes Doctor, Medical Facility, Lab, Pharmacy Billing for services not received Providing a service; billing for a more expensive procedure Double billing Unknown person at shopping mall Misrepresentation - says they are from Medicare or that Medicare wants a person to have a certain service (capping) Employee at Nursing Home, Clinic Sells Medicare #s to organized crime units

6. Salespeople Must Play by the Rules • Health Insurance Salespersons Cannot: • Cold call on phone or in person • Call before 8am • Use high pressure sales tactics • Misrepresent the health plan • Medical Equipment Salespersons Cannot: • Cold call on phone • Canvass senior housing communities • Promise equipment; say they will bill Medicare • Send you equipment you don’t want or need

7. Phone(y) Scams • Many calls come first thing in the a.m.; wake you up • Caller uses psychology (friendly talk or abusive language and overt threats) • Uses the new HealthCare bill to offer you a brand new, more secure Medicare card • Automatically deducts your Part B premium • All they need is your bank checking account!!!

8. Another Phone(y) Scams • The WalMart Gift Card scam • It’s not a gift! • Caller identifies themselves as from WalMart Promotion Center • Says you are the winner of a $1000 gift card • Asks for your email and cell phone # • Then, the bad stuff happens

9. Your Medicare Card is Your Healthcare Credit Card =

10. Read Your MSN as You Would Your Credit Card Statement • Your Medicare Summary Notice is a statement of what Medicare paid to providers who billed your Medicare Number • Read it carefully • Don’t hesitate to question suspicious charges

11. Report Suspicious Behavior to the Senior Medicare Patrol • If someone calls offering special Medicare benefits, or offers to switch to you another plan, call the SMP toll-free fraud hot line (855-613-7080) • If a person calls and says they received a delivery of medical supplies or equipment they did not request, refer them to the SMP • If a person says someone came to their door to help them get home health or provider services, refer them to the SMP