Medicare Facts & Medicare Fraud
Presenter: Kelly McElheny,
Community of Vermont Elders – C.O.V.E./SMP
Southern VT Volunteer and Outreach Coordinator
Kelly@vermontelders.org – http://www.vermontelders.org/wordpress/smp
SMP (formerly “Senior Medicare Patrol”) is a program that exists in all 50 states and is funded by the US Administration on Aging to empower seniors to protect themselves against Medicare errors, fraud or abuse. Since 2003, C.O.V.E. has been the sponsoring agency, administering the federal grant. Anita Hoy <Anita@vermontelders.org> is the Director who also covers the territory north of Rte. 4 / White River Junction, while Kelly McElheny covers the southern part of the state.
This material is also relevant to those persons under the age of 65 who are disabled, on Medicare and who may be “dual eligibles.”
The brochure “Don’t Be a Target of Healthcare Fraud” gets the message across — if you suspect errors, fraud or abuse, report it! By doing so, you will save your benefits and help protect others. Even if you receive a benign phone call, SMP wants to know what is going on. SMP can make a direct referral to the Consumer Assistance Program (CAP) of the Vermont Attorney General’s Office, if the matter falls within that program’s scope. Find other Referral Contacts here.
Some scams, such as completed wire transfers, cannot be reversed. However, CAP does work with Western Union to stop fraudulent wire transfers before they occur. Investigations can also link in the Office of the Inspector General and through them, the FBI.
An investigation resulting in a federal prosecution involved the Scooter Store, effectively shutting down the business which was responsible for some $50 million in Medicare fraud. The scooters were advertised as “free” to beneficiaries, billed to Medicare, leaving seniors to pay the 20% under Part B, thereby owing as much as $10,000. Taking the scooter outside, where it would be most needed, voided the warranty.[1] The industry response has been to now rent scooters instead.
C.O.V.E., the sponsoring agency for SMP, has a number of legislative agenda items including:
- LIHEAP – low income heating assistance
- Transportation – advocating for funding Elderly & Disabled transportation services ($600,000 was allocated statewide in 2013)
- Kinship caregiving – enabling grandparents to have more rights/of a say in raising grandkids
Information about joining C.O.V.E. can be found here.
Tips on protecting yourself from Medicare fraud include:
- Protecting your Medicare number like your Social Security number
- Using the prescription drug drop off sites for unwanted medications. Staying on top of unwanted meds prevents them from being abused by family members and/or caregivers. see: “Drug Diversion in Vermont: When Healing Hands Harm“
The Open Enrollment period for Medicare Advantage and prescription (Part D) coverage runs from October 15 to December 7, 2014. Read the “Annual Notice of Change” to find out if your medications are still listed in the plan. It is unfortunate, but some medications can be dropped from plans during the year with only 10 days notice.
A resource for dealing with Part D issues is the SHIP Coordinator – Sharon O’Neill in
Springfield, VT 1-802-885-6636 or 866-673-8376 http://www.medicarehelpvt.net/aaa.html
On the second Wednesday of the month, the next date being November 12, Kelly gives current information during the “Medicare Minute” at lunch hour at Brattleboro Senior Meals.
One piece of advice during open enrollment is to beware of Third Class (now “Standard”) mail advertising. Do not send back the “request for information” cards contained in the mailings. Doing so allows the companies to solicit business they would not otherwise be legally allowed to do.
Analysing the Medicare Summary Notice will help to identify error, fraud and abuse. Billing errors or denied charges usually involve a health care provider using an incorrect code – wait until the error is corrected and reconciled before paying the bill. If the situation continues, there may be abuse and if it is repetitious across patients, may indicate fraud. SMP does not have to prove fraud in order to report it. The rule is: if you suspect fraud; report it! SMP is looking for volunteers to work peer to peer to detect and report fraud.
Those new to Medicare should review p. 61 of the 2015 Medicare & You booklet, available on-line at http://www.medicare.gov/, which lists 23 free preventative services which can be included as part of a physical or “wellness visit.” Also, this year, folks should be aware that AARP dropped two of its Medicare Advantage plans, leaving only two plans.
The Health Care Advocate may be able to help with health insurance issues that cannot be resolved by SHIP and Vermont Legal Aid offers help with Advance Directives.
Vermont SMP has several interesting programs to share with the community including the Savvy Seniors Performances and exploring ways to bring other resources to the community with the help of the Brattleboro Timetrade.
[1] “The SCOOTER Store shutting down after federal scrutiny, CBS probe,” CBS News, September 14, 2013
http://www.cbsnews.com/news/the-scooter-store-shutting-down-after-federal-scrutiny-cbs-probe/
