Medicare Fraud and Scams

1. Medicare Fraud and Scams Funding provided by the Administration for Community Living (Department of Health and Human Services) California Health Advocates (c) 2018

2. Senior Medicare Patrol (SMP) • SMP is a federally funded project • Established in 1997 • SMPs empower and assist Medicare beneficiaries, their families and caregivers to prevent, detect, and report health care fraud, errors, and abuse through outreach, counseling and education • 54 SMPs across the country

3. SMP Message: • Protect Medical Identity by guarding the Medicare card • Detect Fraudulent Billing by reviewing Medicare Summary Notices and Explanation of Benefits • Report Medicare Fraud by calling SMP at 1-855-613-7080

4. Medicare fraud: It’s fraud associated with these two cards below:

5. Not a victimless crime! 2015: Michigan doctor sentenced to 45 years -Misdiagnosed patients as having cancer, when in fact, they did not. -Gave patients medically unnecessary infusions or injections. Some patients died. -Collected $17.6 million from Medicare.

6. Why Should We Care? • Theft of Medicare/Medi-Cal numbers leads to false claims • Higher premiums • Billions of tax dollars wasted When it comes to Medicare fraud, everyone loses! It should be in everyone’s best interest to save the integrity of the program for future generations.

7. Current trends: • Durable Medical Equipment (DME)/Brace Scams • Hospice • Allegations of Agent Misconduct & Plan Marketing Violations via TV commercials, mail, telephone or in-person • Billing

8. Beware of Durable Medical Equipment (DME) Brace Scams • Unsolicited phone calls offering free braces covered by Medicare. • TV commercials and newspaper ads offering “free” Medicare approved braces to alleviate pain. • Urgently marked postcards notifying beneficiaries of pending eligibility for free Medicare-covered back and/or knee braces. • Suspicious packages containing braces that were not ordered by your doctor. • Charges on your Medicare Summary Notice statements for braces or other DME that you did not want or were not ordered by your doctor.

10. Beware of Questionable Hospice Enrollment • Beware of hospice companies enrolling patients who do not have a terminal illness with 6 months or less to live. • Don’t get tricked by hospice companies offering free services such as housekeeping, home health, nurse visits, durable medical equipment and/or medications for “free". Medicare does not pay for this! • Report hospice companies who give presentations at senior housing facilities and offer assistance with cooking and cleaning. • Beware of calls or unannounced visits by hospice companies offering additional benefits such as help with cooking and cleaning.

11. Beware of Agent/Broker Misconduct • An agent enrolled a beneficiary into a plan without their permission. • Agent told the beneficiary that their physician takes the plan. • Agent offers free trips, meals in return for signing up. • Agent misrepresents the plans benefits. • Agent tells beneficiary they have to sign up or they will lose their Medicare.

12. “Betty and the Medicare Health Plan – Making the Right Choice” is now available in electronic format in English/Spanish (one side is in English/one side is in Spanish).

13. DETECT-Review MSNs & EOBs • Keep track of medical appointments -Use journal or calendar • Look for three things on your statements: -Charges for something you didn’t get -Billing for the same services or supplies twice -Services that weren’t ordered by your doctor • Medicare Summary Notice (MSN) Statement that shows what providers and suppliers billed Medicare in a 3-month period Accessible 24/7 via mymedicare.gov • Explanation of Benefits (EOB)

14. Beware of: • Genetic Testing marketing • New Medicare Card related scams

15. Beware of Genetic Testing Schemes • Promise personalized medicine. Free cancer screenings. • Covered by Medicare! • Cheek swab is taken. • Medicare pays thousands of dollars worth of unnecessary genetic testing.

16. Beware of New Medicare Cards Scams • Caller claims to be from Medicare and offers to send your new Medicare card in exchange for personal information. • Caller offers to activate your new Medicare card. • Caller agrees to send your new Medicare card along with a complimentary back brace. • Caller wants to send you a plastic new Medicare card.

17. PROTECT- Guard Your Card = Treat you Medicare card like a credit card number. • Don’t carry your Medicare card unless you need it. • Only take it to medical appointments, visits to your hospital or clinic, ortrips to the pharmacy. • Never give your Medicare number to a stranger.

18. Common Health Care Scams: • Free Health Screenings – a vendor offers to provide “free” health care screenings, lab tests or other services but asks for a person’s Medicare number. • Counterfeit Prescription Drugs – beneficiaries purchase medication over the Internet to save money, but the drugs they receive are not the right medication or the right dosage. • Insurance Bait & Switch or Cross-selling – licensed agents present information about a Medicare Advantage plan, describing benefits and services that the plan doesn’t actually offer, and then sign people up for a plan that isn’t right for them.

19. SMP Fraud Alerts are available in different languages including: English –Chinese –Spanish –Vietnamese –Korean –Russian –Farsi You may access these fraud alerts by visiting our California Health Advocates website at: https://cahealthadvocates.org/fraud-abuse/medicare-fraud-alerts/

20. SMP placemats available in English and Spanish. To place an order, contact Jasmine at jsuo@cahealthadvocates.org

21. Get connected today! Like & follow our CHA &SMP Facebook pages Subscribe to our e-newsletter www.cahealthadvocates.org To order free materials or schedule a presentation at no-charge, call 1-855-613-7080