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How Do We Stop Medicare Fraud?

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. Why Do We Care?. Every year, Medicare loses billions of dollars Fraud can be dangerous to your health !

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How Do We Stop Medicare Fraud?

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  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

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