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NEWSLETTER
JULY-SEPTEMBER 2017 Published Quarterly
Editor, Kathleen Pursell—AR SMP Director
Senior Medicare Patrol (SMP) programs 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. SMPs are grant-funded
projects of the federal U.S. Department of Health and Human Services (HHS), U.S. Administration for Community Living (ACL).
SPOOFING’S NOT A
JOKE: THOUSANDS HIT
BY PHONE SCAM
April 17, 2017 By: Judy Sarasohn, HHS (Public Affairs) The OIG hotline phone number for reporting fraud —1-800-HHS-TIPS (1-800-447-8477) was spoofed.
A Jacksonville, Florida, woman received a call last month that appeared to be from the HHS
Office of Inspector General’s (OIG) hotline. The caller told her that she had won a $9,000 grant from the federal government and all she had to do was either wire $250 to him through Western Union or give him the confirmation code for a $250 iTunes gift card. The man also wanted her to confirm her name, address and some other personal facts. She became suspicious and eventually ended the call. The Jacksonville woman may not have sent money, but she was scammed into confirming and giving out personal information that could be used to steal money from her bank account or for other fraudulent activity. She wasn’t alone. The OIG hotline phone number for reporting fraud — 1-800-HHS-TIPS (1-800-447-8477) — had been spoofed, a malicious practice of making a phone number appear on caller ID to be legitimate in order to obtain confidential information. Thousands of calls using the spoofed number were made to people across the nation, although only a handful of people have apparently sent money to the
perpetrators, said Thomas O’Donnell, Assistant Inspector General for Investigations at HHS. One criminal case is underway and two people are under investigation.
Just as a reminder:
The federal government never calls you
unsolicited.
The office was first informed of the spoofing attack in February by a member of the public, who reported receiving a call from the hotline number. OIG immediately launched an investigation. O’Donnell said Verizon Communications, which handles calls for several government agencies at a call center at Louisiana State University in Baton Rouge, noted that thousands of outgoing calls were being made from the hotline. But the OIG hotline doesn’t make outgoing calls, it only receives them, O’Donnell said.
The calls typically tell you that you will receive "government grant money" as an incentive for paying taxes on time. The caller will then ask for personal or financial information, such as a Social Security number or bank account number. You may also be asked to wire a payment to cover “processing fees.”
The HHS OIG office is actively investigating this latest scam, working with the FBI and other agencies’ Inspectors General and sharing information and best practices. O’Donnell said other HHS agencies may have also been attacked by scam artists who spoofed their phone numbers. “They can spoof any legitimate number,” he said.
O’Donnell said OIG proactively examined its data systems for a breach, and thankfully, they had not been accessed.
To prevent further nefarious uses of the OIG hotline number, O’Donnell said they have worked with Verizon on ways to prevent the spoofed number from being used for outgoing calls. People with legitimate calls about potential frauds and scams can safely call the hotline or report suspicious calls to [email protected]. They may also file a complaint with the Federal Trade Commission by calling 1-877-FTC-HELP (1-877-382-4357).
How to Protect Your Privacy HHS is aggressively fighting to protect patient privacy on other levels as well. These efforts are important to safeguard against the negative effects that may follow a breach of patient information; assure patient confidence in the health care system, including Medicare and Medicaid; and support the use of electronic health records.
CONTINUED ON PAGE 2
INSIDE THIS ISSUE:
FRAUD RECOVERIES...............Pg 3
Fraud in the News….…..……….Pg 4
Scams….…………………..…… Pg 5
DME Scams…….………………..Pg 6
“Roster Billing” Trend…………. Pg 6
Volunteer Spotlight…...……... ….….Pg 7
What’s KEPRO…………………...Pg 8
MOON…….………….……...........Pg 9
Upcoming Events………...…….....Pg 10
Phone Numbers /Websites......... Pg 11
SMP Mission/Partners....…..…….Pg 12
Unreported fraud, waste, and abuse in Medicare and Medicaid can cost taxpayers millions of dollars each year.
PROTECT, DETECT & REPORT—1-866-726-2916
Since its inception in March 2007, the
Medicare Fraud Strike Force, now
operating in nine cities across the
country, has charged nearly 3,000
defendants who have collectively billed
the Medicare program for more than
$11 billion.
In addition, the HHS Centers for
Medicare & Medicaid Services, working
in conjunction with the HHS Office of
Inspector General, are taking steps to
increase accountability and decrease the
presence of fraudulent providers.
2
SPOOFING’S NOT A JOKE— The Department’s Office for Civil Rights (OCR) enforces the privacy and security rules under the Health Insurance Portability and Accountability Act (HIPAA) for health plans and most health care providers to safeguard patient health information, mitigate harmful effects of a breach, and take remedial action to avoid future breaches.
People, including those who suspect they may be a victim of medical identity theft or other privacy violation, can take advantage of important rights under HIPAA, such as the right:
To inspect and receive a
copy of their medical records;
To have records amended or
corrected when inaccuracies are found; and
To file a complaint if they believe their privacy rights have been violated.
What Should You Do to Be Cyber Secure?
The HHS CyberCARE team also urges you to add a cyber checkup to your annual to-do list. Your online posts, comments, tags and followers create a wealth of personal information that bad actors can use to steal your identity and manipulate you into giving up even more confidential information. The Cyber Doc includes the following suggestions for your annual cyber checkup:
Check your social media privacy settings to make sure you’re sharing information only with friends.
Adjust privacy settings on
your watch computer and the health tracker on your wrist.
Check out social sites you
visit, including ones where you may have left restaurant or handyman reviews and delete any of your Personally Identifiable Information.
The OIG’s O’Donnell also cautioned people not to be fooled by a caller’s knowledge of their name and other personal information. Callers may use a variety of tactics, he said, to obtain some initial personal information, including by working for otherwise legitimate marketing centers. And he stressed that the OIG will never initiate contact with the public through the hotline to request or confirm personal information. Besides, he added, the government doesn’t “sell” grants.
“We don’t hand these [grants] out like candy,” O’Donnell said. “Nobody’s getting free money in this country.”
Protect Yourself from Telephone or Email Scams
No matter how authoritative a caller may sound, privacy specialists urge you to not give or confirm your name or provide any personal information to unknown individuals, including such details as your:
Social Security number
Date of birth
Credit card or bank
account information
Mother’s maiden name
***
Continued from Page 1
Medicare fraud occurs when healthcare services are deliberately misrepresented,
resulting in unnecessary costs to the program, improper payments to providers, or
overpayments. Examples are billing for services that were never provided or billing for
a service or product at a higher rate.
Check your Medicare Summary Notice for suspicious charges and report them.
Sign up for www.mymedicare.gov to check claims regularly.
The Arkansas SMP can help! Call 1-866-726-2916
Medicare Fraud, Waste & Abuse
This newsletter is paid for by a grant (#90MP0022101) from the Administration for Community Living. Its contents are solely
the responsibility of the Arkansas SMP and do not necessarily represent the official views of ACL.
3
Federal Roundup: Health Care Fraud Recoveries Increase
The Sentinel, a publication of the SMP Resource Center www.smpresource.org
May 2017
$5 was recovered for every dollar spent from the HCFAC program. By Kendra Kuehn, MSW Health Benefits ABCs
There were $3.3 billion in health care fraud recoveries in fiscal year (FY) 2016, up from $2.4 billion the previous year, according to the annual Health Care Fraud and Abuse Control (HCFAC) Program Report released by the departments of Health & Human Services (HHS) and Justice. Those funds were deposited in the Medicare Trust Fund or the Department of the Treasury, transferred to other federal agencies administering health care programs such as TRICARE, or paid to private persons (such as relators who filed suits on behalf of the federal government under qui tam provisions of the False Claims Act).
On average in FY 2014-2016, $5 were recovered for every dollar spent from the HCFAC program, according to this report. This was a decrease from the FY 2013-2015 return on investment (ROI) of $6.10 for every dollar spent. The number and types of cases settled or adjudicated during a year can cause the ROI to fluctuate significantly. To account for this effect and the multiyear nature of many cases, a three-year rolling average ROI is reported.
Combatting Fraud In FY 2016, Office of Inspector General (OIG) investigations resulted in 765 criminal actions against those participating in Medicare-or Medicaid-related crimes. Efforts also resulted in 690 civil actions, including civil monetary
penalties (CMPs). CMPs are imposed on providers and suppliers who submit false claims, participate in unlawful referral or kickback schemes, fail to appropriately treat and refer patients at hospital emergency rooms, or engage in other statutorily prohibited activities. OIG excluded 3,635 providers and suppliers engaging in abuse, neglect, or fraud. Exclusions included an osteopath billing Medicare for services never delivered, a nurse assistant convicted of sexual assault, and a clinic owner conspiring to pay kickbacks to beneficiaries when using their Medicare information for fraudulent billing.
At the Department of Justice, the Offices of the United States Attorneys (USAOs) opened 975 criminal health care fraud investigations and filed charges against 802 defendants in 480 cases. During the year, 658 defendants
were convicted of health care fraud-related charges. USAOs also opened 930 new civil
health care fraud investigations and had 1,422 fraud investigations pending at the end of the year.
The departments of Justice and HHS continue to provide support to nine regional Medicare Fraud Strike Force teams, which target those who only engage in health care fraud and do not provide any legitimate health services. Strike Force efforts resulted in charges filed against 230 defendants involved in a total of $2.1 billion in fraudulent
Medicare billing, 131 guilty pleas, 13 jury trials with guilty verdicts against 18 defendants, and 125 defendants sentenced during FY 2016, with an average of 53 months of incarceration. Medicare Fraud Strike Force teams are located in Los Angeles, California; Miami and Tampa, Florida; Chicago, Illinois; Southern Louisiana; Detroit, Michigan; Brooklyn, New York; Dallas, Texas; and Southern Texas.
Preventing Fraud In addition to investigating fraud, OIG makes recommendations for preventative legislative and administrative actions. Informed by agency feedback, these proposals work to close loopholes and reduce
improper payments or conduct. In FY 2016, the Congressional Budget Office (CBO) and department actuaries estimated that these recommended actions resulted in savings of $21 billion to Medicare and $1.1 billion to Medicaid. For further information see the OIG Semiannual Report to Congress.
The SMP program continues to play a crucial role in fraud prevention. OIG has documented over $124.6 million in total savings to Medicare, Medicaid, beneficiaries, and other payers attributed to the SMP projects since the SMP program’s creation in 1997. Since then SMPs have reached 6.6 million beneficiaries in group or one-on-one counseling and more than 30 million people through community outreach events.
The true value of SMPs is difficult to fully determine as the primary focus of the program is teaching beneficiaries how to protect themselves and avoid fraud in the first place. The report acknowledges that programs may not always receive full credit for their efforts. To measure the value of the program, the Administration for Community Living (ACL) awarded a three-year research grant to Tufts University in FY 2013. Tufts’ research will measure beneficiaries’ fraud knowledge, attitudes, and behaviors before and after attending SMP sessions. Preliminary results show that it is possible to show the value of SMP efforts. Final research results are expected in FY 2017. Budgetary Outlook Meanwhile, the new administration and Congress are developing budget proposals for fiscal year 2018. President Donald Trump’s discretionary budget blueprint was released in March 2017. This proposal would increase discretionary spending for HCFAC to $751 million, a $71 million increase over the FY 2017 annualized continuing resolution level. The president’s full budget proposal is expected this month [May 2017] and was not available for analysis at press time.
***
Exclusions included an osteopath billing Medicare
for services never delivered; a nurse assistant
convicted of sexual assault; and a clinic owner conspiring to pay kickbacks to beneficiaries when using their Medicare information
for fraudulent billing.
Tips for family members of Alzheimer’s patients
Family members should fit themselves into the Alzheimer's patient's world, instead of expecting the patient to fit into the family member's world. Here are some tips to help:
Keep it simple: give two choices: pink or blue; Family members should use name tags when visiting such as: YOUR DAUGHTER LINDA; "Holy Fibs" are okay - go along to avoid conflict; Redirect their attention -If patient wants to go home, ask them, “what would you do first on arriving home?” During meals, assist from in front of patient, not from side, and call out food names while assisting. Don’t correct-who cares if patient gets details wrong! There are more important things than "being right". Part on a pleasant note.
FRAUD IN THE NEWS —
Nursing Home Operator Agrees to Pay Prestige Healthcare has agreed to pay almost $1 million to resolve allegations that it violated the False Claims Act regarding its role in an
alleged scheme to falsely bill Medicare for unnecessary genetic testing. The United States alleged that Prestige failed to ensure that physician
orders were obtained for the genetic testing prior to its being conducted and that Prestige physicians were not aware of and did not agree with
the testing’s medical necessity. It also alleged that Prestige failed to ensure that its patients were appropriately informed of the testing prior to
its being conducted and given the opportunity to decline.
To read a Department of Justice press release, go to: https://www.justice.gov/usao-wdwi/pr/prestige-healthcare-agrees-pay-nearly-1-million-role-alleged-false-billing-genetic
Detroit-Area Physician Pleads Guilty In a $17.1 million Medicare fraud scheme, a physician admitted he saw patients who did not qualify for his services and whose visits were
billed to Medicare at the highest billing codes. He also admitted that he prescribed to patients medically unnecessary narcotics, such as
Vicodin, in exchange for the ability to bill Medicare for the patients' visits. To read a Department of Justice press release, go to:
https://www.justice.gov/opa/pr/second-detroit-area-physician-pleads-guilty-171-million-health-care-fraud-scheme
The Arkansas Senior Medicare Patrol (SMP) is federally funded by a grant from the Administration on Aging (AoA) Administration for Community Living (ACL) and administered by the Arkansas Department of Human Services, Division of Aging & Adult Services
4
State Health Insurance
Information Program (SHIIP)
Contact Arkansas SHIIP
800-224-6330 for personalized,
one-on-one counseling and assistance with
understanding Medicare!
SCAM TIP!
The federal government
never calls you
unsolicited.
U nscrupulous doctors, pharmacists and medical suppliers sometimes form an alliance and
overprescribe medications, ointments and supplies to patients. The providers then bill Medicare and divide the profits among themselves. Medications and other supplies are oftentimes substituted with generic or less expensive products, unbeknownst to the patient.
Always a Step Ahead
Scamsters are always a step ahead! The best way to protect yourself from being victimized is to be aware of the most recent types of fraud/scams emerging locally and around the country. Sign up to receive the quarterly Arkansas SMP Newsletter – Call 866-726-2916.
Tips:
Be wary of offers for FREE medicine or medical
equipment – these are probably scams.
Do not give out your Medicare number to a stranger,
especially over the phone.
Your Primary Care Physician (PCP) should write your
prescription(s). Never allow a doctor you've never met to prescribe any medications, medical equipment or home health care services.
Review your monthly Medicare statement to see if it
contains billing charges that seem suspicious or in error.
Report suspicious or fraudulent activity to the
Arkansas SMP – 866-726-2916.
If you want to take an active role, join the Senior Medicare Patrol (SMP), a nationwide network of volunteers who educate the public about Medicare fraud. Contact the Arkansas SMP for more information or to volunteer by calling 866-726-2916.
Be aware of the following SCAM(s):
Report all scams to the Arkansas SMP — 1-866-726-2916
CHANGES ARE COMING TO YOUR MEDICARE CARD—
Have you heard you will be receiving a new Medicare card? Are you wondering when? This won’t
happen until April 2018 but scammers are already ahead of the game and using this as an opportunity for fraud.
This change to remove social security numbers from Medicare cards is to help prevent fraud and protect your identity.
Currently, for most people, their Social Security number is their Medicare number. This makes collecting Medicare
numbers an easy target for scammers to steal your identity, open new credit cards or take out loans in your name. The
new number, however, will not be tied to your Social Security number and is therefore more secure.
Scammers are able to use this to their advantage by calling Medicare beneficiaries claiming to be with Medicare and
stating that they must confirm their current Medicare numbers before sending the new card. Others call saying there
is a charge for the new card and are collecting beneficiaries’ personal information. The new card will be mailed to
you automatically; and there is not charge. It is FREE!
PLEASE BE AWARE THAT there is no charge for your new card and Medicare will never call you for your
information. They already have it. Government agencies like Medicare, the IRS and Social Security WILL NOT
CALL YOU!
If you receive calls about this change or other suspicious solicitations, hang up and call the Arkansas Senior Medicare
Patrol (SMP) at 1-866-726-2916.
US DHHS HOTLINE — The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG)
recently confirmed that the OIG Hotline telephone number, 1-800-HHS-TIPS (1-800-447-8477), is being used as
part of a telephone spoofing scam! Scammers represent themselves as HHS OIG Hotline employees and can alter
the appearance of the caller ID to make it seem as if the call is actually coming from the HHS OIG Hotline . The
perpetrator may use various tactics to obtain or verify personal information, which can then be used to steal money
from an individual’s bank account or for other fraudulent activity.
The Hotline telephone number will not be used to make outgoing calls and individuals should not answer calls
from 1-800-HHS-TIPS (1-800-447-8477).
Protect your personal information—guard against providing personal information during calls that purport to be
from the HHS OIG Hotline.
It is still safe to call into the HHS OIG Hotline to report fraud.
Let calls from
unfamiliar numbers
go to voicemail.
Legitimate callers
will most likely
leave a message -scammers won’t!
By Nat Wood
June 20, 2017
THE FTC DOESN’T NEED YOUR BANK INFO — Some people have gotten an email that claims to be from
Maureen Ohlhausen, the FTC’s Acting Chairman. But it’s not. The email asks you to give your bank account
information – so, it says, you can get money from the government’s settlement with Western Union. The email is a
scam to steal your financial information. And it’s just the latest variation of an imposter scam.
If you get an email like this, don’t respond or click on any links. You can forward it to the FTC at [email protected].
The FTC is involved in a $586 million settlement with Western Union, but the U.S. Department of Justice will run the
refunds process. And it hasn’t started yet.
The FTC will never ask for money, your Social Security number, or any banking information so you can apply for a
refund or cash a check. If the FTC needs to get money to you, they usually send a check through the mail.
HANG UP ON
PHONE FRAUD!
5
Walkers and Wheelchairs and
Braces, Oh My!
By Jenna Gladfelter
SMP-NY Program Director
H ave you ever received a postcard in
the mail saying you’re eligible for a
free back brace? Maybe someone has called
to tell you that your doctor has approved you
for a free knee brace – all you need to do is
provide your Medicare number! Sounds like
a good deal, right? Maybe too good?
Unfortunately, it is. Durable medical
equipment (aka DME) scams are some of
the most common forms of health care
fraud. But what exactly is DME? And why
are these offers considered scams?
First, DME is designed to mainly be used in
your home. It could be a walker, a
wheelchair, a hospital bed, or some kind of
brace. These pieces of equipment are
intended to uniquely fit you! For example, a
knee or back brace will require your
measurements. A wheelchair will not only fit
your body but also be specially measured
to ensure you can move throughout your
home. A DME supplier is required to
thoroughly gather this information and to
ensure a perfect fit.
Secondly, there are several reasons these
phone calls and postcards could be
considered scams. To start, Medicare
representatives are not allowed to solicit by
phone. And in order for Medicare to cover a
piece of DME in the first place, you need a
prescription from a doctor stating why you
need it. Lastly, DME is covered by your Part
B plan and almost always has a copayment.
So what’s in it for the scammer? Two things: personal information and money!
With these scams, the person on the phone
will almost always ask for your Medicare
number, which also happens to be your
Social Security number. That information
in the wrong hands could be really
harmful. Most of the time, scam artists
will then bill Medicare for a piece of
equipment – sometimes more expensive
than the one they may have sent you –
and collect the money for themselves.
Not only can they wrongfully use your
Medicare benefits but they also could,
and often do, commit identity theft. With
your Social Security number, they are
able to open bank accounts and credit
cards and request loans in your name –
all without your knowledge or
permission.
This sounds bad. How can I protect myself?
We’re glad you asked…
We like to tell people that knowledge is
power. By knowing how scammers operate,
you can stop them in their tracks. It’s
important to be wary of any offers that
promise “free” products or services. After
all, there’s no such thing as a free lunch!
So, don’t be afraid to hang up the phone or
toss that postcard in the trash.
However, you don’t just have to play defense.
YOU can help us fight fraud! We encourage
you to be proactive and report any
suspicious activity to the Arkansas Senior
Medicare Patrol. This information not only
shows us if scammers are targeting a
specific neighborhood, zip code, or city, but
it also helps us report fraud trends to the
proper authorities.
If you ever have any questions or concerns,
don’t hesitate to contact the Arkansas
Senior Medicare Patrol. We’re here to help
you.
ARKANSAS SENIOR MEDICARE PATROL —866-726-2916 —
COMBATTING
OVER-UTILIZATION IN
LONG TERM CARE AND
ASSISTED LIVING
FACILITIES
Over the past few years an emerging trend
has been seen with physicians and nurse
practitioners providing non-medically
necessary services to residents in nursing
homes and assisted living facilities. This
trend is often referred to as “Captive
Audience” or “Roster Billing”.
WHAT IS CAPTIVE AUDIENCE AND
ROSTER BILLING?
Captive Audience refers to locations
where multiple Medicare beneficiaries are
housed. This includes nursing facilities,
assisted living facilities, and senior living
communities. Roster Billing is often done
from places where there is a “Captive
Audience”. In a Roster Billing scenario a
physician or nurse practitioner will obtain
a list (roster) from the facility they are
visiting with all the active residents, they
will then bill a Subsequent Nursing
Facility Care visit (CPT codes 99307-
99310) for each resident regardless of
need or if they were actually seen. In these
scenarios we often see patients getting
billed for visits every two to four weeks,
or in the most aberrant cases weekly.
WHAT MEDICARE SAYS
Codes 99307-99310 (Subsequent Nursing
Facility Care, per day) shall be used to
report federally mandated physician visits
and other medically necessary visits.
Medicare will pay for federally mandated
visits that monitor and evaluate residents
at least once every 30 days for the first 90
days after admission and at least once
every 60 days thereafter.
While the Medicare policy states that
these codes should only be used one every
60 days after the first 90 days of
admission, they can be used more
frequently if the patient has an
exacerbation of their condition requiring a
physician visit.
HOW TO IDENTIFY ROSTER
BILLING
The most important step in identifying
Roster Billing is reading the Medicare
Summary Notices.
If there is a constant charge for a nursing
facility visit or multiple visits every
month, this could be the first clue that a
physician is Roster Billing. Another clue
would be if a beneficiary states that the
same physician or nurse practitioner
comes around to see them every two
weeks, but no real medical exam takes
place. Often times these visits will just
include talking with the beneficiary or
taking their vitals. Lastly, be mindful of
specialists that appear without a request
such as podiatrist or psychiatrist.
REMEMBER….beneficiaries always
have a choice on what physician they do
or do not want to see.
Submitted by: Julie Doriety,
Program Integrity Supervisor
for AdvanceMed
6
This newsletter was supported in part by a grant (No. 90MP0022101) from the Administration for Community Living (ACL). Grantees carrying out projects under
government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not necessarily represent official ACL or DHHS policy.
Really Special and Valuable People!Really Special and Valuable People!Really Special and Valuable People! SMP VOLUNTEERS IN THE SPOTLIGHT!
The Arkansas SMP is currently recruiting volunteers! COME JOIN THE FUN!
For more information, please contact Dee Edwards,
Arkansas SMP Volunteer Coordinator
—1-866-726-2916— SMP - Empowering Seniors to Prevent
Medicare Fraud 7
Kathleen Pursell, Dee Edwards and
Jeanett Stuart. our new SMP Volunteer
from Fountain Place in Cherokee
Village. Welcome aboard Jeannett!
Susan Mullins, Activities Director and Tricia
Jones, Director of the Fountain Place Christian
Retirement Community, Cherokee Village.
Susan signed up to volunteer for SMP!
We are happy to have you Susan!
Dee Edwards and SMP Volunteer
Ricarda Snellback! Welcome back
Ricarda!
Dee Edwards and SMP Volunteer
Saundra Calhoun from Wesley on the
Ridge in Jonesboro.
Saundra Calhoun conducting her FIRST SMP Fraud Bingo!
Dee Edwards with new SMP
Volunteer Betty Williams from
Golden Age Apartments in Pine
Bluff! Welcome Betty!
NEW SMP Volunteer
Judy McGuire from Red
Oaks Landmark Missionary
Baptist Church—Hot
Springs.
8
Are you a QMB and have been
wrongfully billed for Medicare costs?
If you are enrolled in the Qualified Medicare Beneficiary
(QMB) Program, you should not be billed for Medicare-
covered medical services, equipment, or supplies. Your
Medicare premiums, deductibles, coinsurance, and
copayments are all covered by Medicaid.
There are reports from the Centers for Medicare &
Medicaid Services (CMS) of people being wrongfully
billed even though they have QMB coverage. Also, the
Consumer Financial Protection Bureau (CFPB) receives
reports that debt collectors repeatedly attempted to collect
these types of bills.
If you are wrongfully billed or receive calls from debt
collectors on bills that were wrongfully sent, you can:
Contact the provider or debt collector and tell them you
are enrolled in the QMB Program and cannot be
charged for Medicare deductibles, coinsurance, and
copayments. You have the right to a refund for any
payments you’ve already made.
Call 1-800-MEDICARE (1-800-633-4227) if the
medical provider won’t stop billing you or refuses to
issue a refund, and they can ask the provider to stop
improper billing and to refund any incorrect payments
you made.
Submit a complaint online or call the CFPB
at 1-855-411-2372.
https://www.consumerfinance.gov/about-us/blog/what-do-if-
youre-wrongfully-billed-medicare-costs/
DID YOU KNOW?
You can electronically receive your Medicare Summary
Notices (eMSN’s)!
Visit mymedicare.gov to find out how to get eMSNs.
If you choose to do so, you’ll get a monthly email
(eMSN) instead of having to wait for the paper copy to
be mailed every 3 months.
Go to www.mymedicare.gov and click on “Create an
account.”
What is KEPRO? KEPRO, Arkansas’ Quality Improvement Organization, provides three services for beneficiaries:
1. Discharge appeals 2. Beneficiary complaints 3. Immediate Advocacy
KEPRO’s services are free for Medicare beneficiaries and their representatives
For more information: www.keproqio.com; 216-339-4775; [email protected]
Beneficiaries calling for Immediate Advocacy should choose option 1 on the first prompt followed by option 2 to be connected to the beneficiary complaint department.
DO YOU EXERCISE?
Many seniors live on a fixed income
that does not leave them with enough
discretionary income to purchase a
health club membership or even buy exercise DVDs.
Reap the benefits of fitness by walking (outdoors or in
a public space like a shopping mall); check out video
streaming exercise routines via YouTube; check out
exercise DVDs from the library; or click on this link to
follow these FREE printable exercise worksheets
Resource:
www.caregiverstress.com/geriatric-professional-resources/professional-
development/5-social-determinants-that-can-impact-senior-exercise/
DON’T ACCEPT ITEMS
received through the mail
that you didn’t order. Refuse the delivery!
Don’t open it, and return it to the sender.
Keep a record of the sender’s name and the date
you returned the item(s).
DME
FRAUD! A GREAT RESOURCE
for answers to many
questions you may have
about your Medicare…
Medicare Interactive:
https://www.medicareinteractive.org/
9
Don’t let
others
become
victims!
Pass it on…
Help make
others aware of
fraud and
how to avoid
scams and
financial
abuse.
faceboo
k.co
m/arsm
p
What you should know
about Medicare-covered
orthotics…
Some diabetic equipment
suppliers are reacting to
lower Medicare
reimbursements for testing
strips by aggressively
marketing other equipment,
such as back braces, that are
not subject to competitive
bidding rules.
Beneficiaries and their
caregivers need to know that
Medicare covers back braces,
knee braces, cervical collars,
and other braces as orthotics,
when they are “furnished
incident to physicians’ services
or on a physician’s order,” and
“used for the purpose of
supporting a weak or deformed
body member or restricting or
eliminating motion in a
diseased or injured part of the
body.”
“For an item to be covered by
Medicare, a detailed written
order (DWO) must be received
by the supplier before a claim
is submitted.
If the supplier bills for an item
… without first receiving the
completed DWO, the item will
be denied as not reasonable
and necessary.”
Special documentation rules,
including justification for the
specific item in the ordering
physician’s records, apply to off
-the-shelf orthotics.
Medicare doesn’t cover back
braces without full
documentation of medical
necessity and that suppliers
that receive Medicare
payments for unneeded,
unwanted, or substandard
equipment run the risk of
prosecution for False Claim Act
violations.
Some DME suppliers that
furnish mail-order diabetic
supplies are using
telemarketers to make
repeated calls to existing
customers with offers of free or
low-cost back braces. Some
beneficiaries give in to the
pressure or persuasion and
authorize the suppliers to
contact their physicians with
faxed orders.
Call 1-866-726-2916 to receive the SMP Newsletter.
LOOKING GOOD
My face in the mirror isn't wrinkled or drawn.
My house isn't dirty. The cobwebs are gone.
My garden looks lovely and so does my lawn.
I think I might never put my glasses back on.
Medicare
Outpatient
Observation
Notice (MOON)
(Effective March 8, 2017 hospitals must begin providing the MOON to patients in observation status for more than 36 hours.)
The MOON is a
standardized notice to
inform beneficiaries
(including Medicare
health plan enrollees)
that they are an
outpatient receiving
observation services and
are not an inpatient of
the hospital or critical
access hospital (CAH).
The MOON is mandated
by the Federal Notice of
Observation Treatment
and Implication for Care
Eligibility Act
(NOTICE Act), passed
on August 6, 2015.
The NOTICE Act
requires all hospitals and
CAHs to provide written
and oral notification
under specified
guidelines.
For your free copy of the SMP brochure entitled:
“DIABETES SCAMS — What Should you Do?”
Call —1-866-726-2916
Sign up to receive
Scam Alerts by calling 866-726-2916.
CMS will issue new Medicare cards with a new unique, randomly-assigned number called a Medicare Beneficiary Identifier (MBI) to replace
the existing Social Security-based Claim Number. CMS will start mailing new cards to people with Medicare benefits in April 2018. All Medicare cards will be replaced by April 2019.
LAUGH! Not only does laughter make you feel good, its positive effects stay with you long
after the chuckling subsides. Research shows that laughter lowers stress hormones, relaxes
muscles, improves mood, and eases anxiety. According to HelpGuide.org, “Humor helps you keep a
positive, optimistic outlook through difficult situations, disappointments, and loss.”
REMINDER!
Scammers are skilled liars.
They’ll say anything or
claim to be anyone to get
your personal and financial
information – then they’ll
use it to steal money from
your accounts or commit
other crimes.
SMP is a nationwide federal grant
program funded in part by the U.S.
Administration for Community Living.
The Arkansas SMP grant is
administered by the
Arkansas Department of
Human Services
Division of Aging & Adult Services.
Upcoming Arkansas SMP Activities DATE ACTIVITY COUNTY
July 10-13 SMP/SHIIP National Training Meeting—Austin TX Texas
July 17 SMP Fraud Bingo—Christopher Homes—West Helena Phillips
July 18 SMP Fraud Bingo — Wesley on the Ridge—Jonesboro Craighead
July 25 Volunteer Training—SEARSVP Jefferson
July 26 St. Anthony’s Volunteer Recruitment—Morrilton Conway
July 28 SMP Exhibit Booth — Hope for the Future — Conway Faulkner
August 3-5 SMP Exhibit Booth — AEMTA Conference — Hot Springs Garland
August 18 SMP Exhibit Booth — Hope for the Future — Newport Jackson
August 22 Volunteer Training—MDCC Phillips
August 29 SMP Fraud Bingo—Senior Center—Morrilton Conway
September 8 SMP Presentation—Hope for the Future—Helena Phillips
September 12 Arkansas SMP Quarterly Advisory Council Meeting—Little Rock Pulaski
September 14 SMP Exhibit Booth— Hope for the Future— Harrison Boone
September 14 SMP Exhibit Booth — Village House—Rioradan Hall—Bella Vista Benton
September 26 SMP Exhibit Booth — ARTA Convention — Benton Saline
September 26 SMP Exhibit Booth — Senior Circle — Siloam Springs Benton
September 27 SMP Presentation—Watson Chapel Baptist Church—Pine Bluff Jefferson
October 4 SMP Exhibit — AHAA Annual Conference — Embassy Suites — Little Rock Pulaski
October 17 S.A.L.T. — Rogers Benton
October 20 SMP Presentation—Hope for the Future — Magnolia Columbia
October 21 SMP Exhibit — Arkansas Democrat-Gazette SENIOR EXPO—Little Rock Pulaski
October 27 SMP Presentation— 8th Street Missionary Baptist Church—NLR Pulaski
December 5 SMP Volunteer Appreciation Pulaski
December 7 SMP Presentation — Lunch & Learn—Faith UMC — Little Rock Pulaski
We would welcome any opportunity to present the SMP message statewide.
Please contact the Arkansas SMP to schedule a presentation in your area—1-866-726-2916.
10
IMPORTANT PHONE NUMBERS:
AANHR—AR Advocates for Nursing Home Residents 501-450-9619
AFMC—AR Foundation for Medical Care 1-888-354-9100
Area Agency on Aging 1-800-986-3505
AG-Attorney General (Consmr Prot Div) 1-800-482-8982
AG Medicaid Fraud Hotline 1-866-810-0016
APS—Adult Protective Services (DHS) 1-800-482-8049
Arkansas Rehabilitation Services 1-800-981-4463
AR SMP (Healthcare Fraud Complaints) 1-866-726-2916
Better Business Bureau (BBB) 501-664-7274
CMS—(Medicare)— (Centers for Medicare and Medicaid Services)
(1-800MEDICARE) 1-800-633-4227
Community Health Centers of AR 1-877-666-2422
Coordination of Benefits 1-855-798-2627
DHS (Customer Assistance Unit) 1-800-482-8988
Do Not Call Registry 1-888-382-1222
Elder Care Locator 1-800-677-1116
El Dorado RSVP 1-870-864-7080
Federal Trade Commission
Report STOLEN IDENTITY 1-800-438-4338
ICan—Increasing Capabilities Access Network 501-666-8868
KEPRO -AR QIO(Quality Improvmnt Org.) 1-844-430-9504
Medicaid—(Claims Unit) 1-800-482-5431
Medicaid Inspector General (OMIG) 1-855-527-6644
MEDICARE (CMS 1-800-MEDICARE) 1-800-633-4227
Medicare Part D 1-877-772-3379
Medicare Rights Center 1-800-333-4114
Mid-Delta Community Consortium 1-870-407-9000
NCTRC (Nat’l Consumer Tech Resrc Cntr 1-877-808-2468
Oaklawn Foundation/Center on Aging 501-623-0020
OIG-Nat’l Medicare Fraud Hotline 1-800-HHS-TIPS
(OIG) Office of Inspector General 1-800-447-8477
OLTC—Office of Long Term Care 1-800-LTC-4887
OLTC—Abuse Complaint Section 501-682-8430
Ombudsman—State Ofc of Long Term Care 501-682-8952
Resource Center (ADRC) 1-866-801-3435
(DHS’S Choices in Living Resource Center)
RSVP of Central Arkansas 501-897-0793
Senior Circle (Northwest Health System) 1-800-211-4148
SHIIP (Senior Health Ins.Info Program) 1-800-224-6330
SMP Locator—(locate an SMP outside AR) 1-877-808-2468
SSA (Social Security Administration) 1-800-772-1213
Little Rock Office 1-866-593-0933
SSA Fraud Hotline 1-800-269-0271
South Central Center on Aging 1-866-895-2795
Texarkana Regional Center on Aging 1-870-773-2030
Tri-County Rural Health Network 1-870-338-8900
UALR Senior Justice Center 501-683-7153
UofA Cooperative Extension Service 501-671-2000
HELPFUL WEBSITES:
ADRC—AR Aging & Disability Resource Center (DHS)—
www.choicesinliving.ar.gov/
AR Advocates for Nursing Home Residents—
www.aanhr.org; e-mail: [email protected]
AR Long Term Care Ombudsman Program—
www.arombudsman.com
Arkansas 2-1-1—www.arkansas211.org
(Get Connected. Get Answers) —1-866-489-6983
Arkansas Aging Initiative—http://aging.uams.edu/?
id=4605&sid=6
Arkansas Attorney General—www.arkansasag.gov
Arkansas Attorney General Consumer Protection
Division—e-mail: [email protected]
Area Agencies on Aging—www.daas.ar.gov/aaamap.html
Arkansas Foundation for Medical Care—www.afmc.org
Arkansas SMP—www.daas.ar.gov/asmp.html
BBB (Better Business Bureau)— scams and alerts— https://www.bbb.org/scamtracker/arkansas/
CMS (Medicare) Centers for Medicare and Medicaid Services—
www.cms.hhs.gov
Do Not Mail—www.DMAchoice.org
Elder Care Locator—www.eldercare.gov
H.E.A.T—www.stopmedicarefraud.gov/
(Healthcare Fraud Prevention and Enforcement Action Team)
ICan AT4ALL—Tools for Life—www.ar-ican.org
MEDICAID—www.Medicaid.gov
MEDICAID INSPECTOR GENERAL (OMIG)—
http://omig.arkansas.gov/fraud-form
MEDICARE—www.medicare.gov
Medicare Interactive Counselor—
www.medicareinteractive.org
Hospital Compare—www.hospitalcompare.hhs.gov
MyMedicare.gov—www.mymedicare.gov
(Access to your personal Medicare claims information)
MyMedicareMatters.org (National Council on Aging)
Office of Long Term Care—http://
humanservices.arkansas.gov/dms/Pages/oltcHome.aspx
Office of Inspector General (OIG)—email:
Pharmaceutical Assistance Program—
medicare.gov/pap/index.asp
Physician Compare—www.medicare.gov/find-a-doctor
SMP Locator—SMPResource.org (locate an SMP outside of AR)
Social Security Administration (SSA)—www.ssa.gov
SSA OIG—Report SS Fraud—https://oig.ssa.gov/report
TAP—www.arsinfo.org (Telecommunications Access Program)
UofA Cooperative Extension Service—
www.uaex.edu (or) www.arfamilies.org
Working Disabled—www.workingdisabled-ar.org 11
SENIOR MEDICARE PATROL (SMP) MISSION
“To empower and assist Medicare beneficiaries, their
families, and caregivers to prevent, detect, and report
health care fraud, error, and abuse through outreach,
counseling, and education.”
TO PREVENT HEALTHCARE FRAUD—
Protect Personal Information
* Treat Medicare/Medicaid and Social Security numbers like credit card numbers.
* Remember, Medicare will not call or make personal visits to sell anything!
* READ and SAVE Medicare Summary Notices (MSN) and Part D Explanation
of benefits (EOB), but shred before discarding.
Detect Errors, Fraud, and Abuse
* Always review MSN and EOB for mistakes.
* Compare them with your Personal Health Care Journal.
* Visit www.mymedicare.gov to access your personal account online to look
for charges for something you did not get, billing for the same thing more than
once, and services that were not ordered and/or you never received.
Report Mistakes or Questions
* If you suspect errors, fraud, or abuse, report it immediately! Call your provider
or plan first.
* If you are not satisfied with their response, call the Arkansas SMP.
TO RECRUIT & TRAIN VOLUNTEERS—
* Retired seniors;
* Retired health-care providers; or
* Retired professionals, e.g., teachers, accountants, attorneys, investigators, nurses.
Arkansas Senior Medicare Patrol (SMP)
P. O. Box 1437 Slot S530
Little Rock, AR 72203-1437
http://www.daas.ar.gov/asmp.html
FACEBOOK.COM/ARSMP
AR SMP PARTNERS
El Dorado Connections RSVP El Dorado, AR 870-864-7080
RSVP of Central Arkansas Little Rock, AR 501-897-0793
Oaklawn Foundation Hot Springs, AR
Mid Delta Community Consortium West Helena, AR
870-407-9000
Tri County Rural Health Network Helena, AR
870-338-8900
Texarkana Regional Center on Aging
Texarkana, AR 870-773-2030
South Central Center on Aging Pine Bluff, AR 870-879-1440
South East Arkansas RSVP Pine Bluff and Stuttgart, AR
870-673-8584
Senior Health Insurance Information Program (SHIIP)
Little Rock, AR 800-224-6330
To receive the Arkansas SMP Newsletter electronically
email: [email protected]
Current and archived newsletters available at:
www.daas.ar.gov/asmpnl.html
To Report Medicare Fraud, Waste & Abuse
Call the Toll-Free Helpline 8:00am—4:30pm
1-866-726-2916