Medicare loses $13 billion each year to fraud and abuse.

What is Medicare Fraud?

The most common types of Medicare fraud start with stealing your “medical identity” by getting your Medicare number. Once they have your number thieves can bill Medicare for services and supplies that were never provided. Most fraud is done by common criminals with 2 to 3% done by health care providers.

Examples of these types of fraud are:

• billing for services or supplies that were not provided.
• billing twice for the same service or item.
• using unethical or unfair marketing strategies, such as offering beneficiaries free groceries or transportation to switch providers.

More examples of Medicare fraud

Details of specific Medicare fraud scams

The most common types of Medicare abuse are incidents or practices of providers that are inconsistent with sound medical and business practices. These practices result in unnecessary costs to the program, improper payments, or payment for services that fail to meet professionally recognized standards of care or conducting procedures that are medically unnecessary. Some examples of abuse are:

• Excessive charges for services or supplies
• Routinely submitting duplicate claims
• Improper billing practices such as:
• Exceeding the limiting charge
• Billing Medicare at a higher fee schedule rate than for non-Medicare patients
• Routinely submitting bills to Medicare when Medicare is not the beneficiary’s primary insurer
• Collecting more than 20 percent coinsurance or the deductible on claims filed with Medicare
• Breach of the Medicare participation or assignment agreements
• Claims for services that are not medically necessary

What Can You Do To Protect Yourself?

• Protect your Medicare number as you do your credit card numbers and your ATM pin. Never give your Medicare number to a stranger, or to anyone who calls you. remember Medicare and Medicaid do not call you to sell you anything.
• Always read your Medicare Summary Notice, and your Part D explanation of benefits, and verify that you did receive the supplies and services listed.
• Do not believe people who say they will give you something free in return for your Medicare number.
• Ask questions if something does not make sense or if it sounds too good to be true.

If you suspect fraud call your provider, or insurance company. If you are not comfortable doing that, call your local SMP (Senior Medicare Patrol).
Get the address and phone number of your local SMP here. 

Another good website is www.stopMedicarefraud.gov.

Read more here.

Read the full article here.

This is  a multi-year award of up to $5.7 million that will reimburse the cost of assisting patients to make safe transitions between care settings, such as from hospital to home.

We  would like to thank our many community partners in this venture. Stay tuned for more information on Project Impact!

The Exchange will provide a consumer-friendly online portal allowing people to easily compare their health insurance choices and enroll in what works best for them. Individuals will also have access to tax credits and cost-sharing subsidies to make coverage more affordable. Another part of the Exchange called the Small Business Health Options Program (or SHOP) will allow small businesses with up to 50 employees to purchase group health insurance for their employees.

If you are an employer with up to 50 employees, the HCA wants to hear what you think about health insurance for your employees. Your input will help the HCA make important decisions about the design of the new Exchange and the SHOP.

How You Can Help

• Step 1 – Take a quick survey
This brief yet powerful survey is being sent to over 30,000 small employers around the state, soliciting opinions about potential Exchange elements. The HCA strongly believes that getting the direct, personal input of employers like you upfront will be key to helping them shape an effective Exchange.

• Step 2 – If you have 5 – 50 employees, you will have the opportunity at the end of the survey to sign up for one of eight focus groups happening in mid-November and receive $100 for your time. Each of these 90-minute sessions is limited to 24 participants and will give small employers an opportunity to share their thoughts and opinions regarding health insurance for their employees. You’ll find more details and sign up instructions within the survey.

To ensure objectivity throughout the process, an independent consulting firm, Milliman, will be conducting the survey and focus groups.

Thank you in advance for taking time to share your thoughts! The HCA looks forward to receiving feedback from as many employers as possible.

During the Annual Enrollment Period, from October 15th to December 7th, Medicare enrollees can join, switch, or drop their Medicare Part D Prescription Drug Plan and/or Advantage Plan for 2012. We can help enrollees review their current plans and compare them with other options.

SHIBA (Statewide Health Insurance Benefits Advisors) is a free, unbiased, confidential service of the Office of the Insurance Commissioner hosted by WAHA. You can also call 788-6533 for one-on-one assistance from one of our knowledgeable volunteers.