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What Can YOU Do to Prevent Healthcare Fraud?

Learn about Medicare fraud and abuse, how it affects everyone, and real-life cases. Follow three steps to prevent healthcare fraud: Protect yourself, Detect fraud, and Report suspected cases. Get involved with SMP program to help combat fraud.

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What Can YOU Do to Prevent Healthcare Fraud?

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  1. What Can YOU Do to Prevent Healthcare Fraud? Presented by: Funded by: This project is supported in part by grant numbers 90MP0026 and 90MP0127 from the U.S. Administration on Aging, Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official Administration on Aging policy.

  2. What is Medicare Fraud? Intentionally billing Medicare for services that were not received, or billing for a service at a higher rate than is actually justified.

  3. What is Medicare Abuse? Providers supply services or products that are not medically necessary or that do not meet professional standards.

  4. Examples of Fraud & Abuse

  5. Medicare Fraud, Errors, and Abuse Affect… Everyone • Billions of taxpayer dollars lost to improper claims • Medicare trust fund at risk Medicare Beneficiaries • Higher premiums • Less money for needed benefits • Quality of treatment

  6. Real Life Cases: Medicare Fraud & Abuse in Illinois

  7. Three Steps to Prevent Health Care Fraud • Protect 2) Detect 3) Report

  8. Step 1: Protect Yourself from Medicare Fraud and Abuse

  9. Step 2: Detect Medicare Fraud & Abuse • Use your Personal Health Care Journal • Review Medicare Summary Notices (MSNs) and other statements for: 1. Services you didn’t receive 2. Double-billing 3. Services not ordered by your doctor • Access your Medicare information at www.MyMedicare.gov.

  10. Step 3: Report Suspected Medicare Fraud and Abuse • Call the provider. • Gather information and documentation. • Contact your SMP. • This is a free and confidential service!

  11. SMP Volunteers Would you like to: • Help other Medicare beneficiaries protect, detect and report? • Give presentations? (like this one!) • Provide one-on-one counseling? • Perform administrative work? • Join the SMP program as a volunteer!

  12. Contact your State SMP: Illinois SMP at AgeOptions Visit us online: www.illinoisSMP.org • For more information Call Toll-free: (800)699-9043 • To report suspected fraud/abuse • For training, speakers, and/or materials • To volunteer with the SMP program

  13. Questions?

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