Innovations of virginias aaa vg co_a - medicare fraud

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Transcript of Innovations of virginias aaa vg co_a - medicare fraud

What the Healthcare Consumer Needs to Know

About Medicare Fraud?Presented by: Marly Flores, Director, Virginia SMP

Funded by: The Administration on Community Living, US Department of Health & Human Services

Medicare Fraud, Errors, and Abuse Affect…

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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

Consequences of Medicare Fraud, Errors, and Abuse

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What is the Senior Medicare Patrol?

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The SMP mission is… to 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.

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What is Medicare?

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Parts of Medicare

Medicare Supplement Insurance (Medigap) is not part of Medicare.7

Medicare Numbers and Cards

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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

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What is Medicare Abuse?

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Providers supply services or products that are not medically necessary or that do not meet professional standards

Examples of Fraud & Abuse

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What about Errors?

Only a review and investigation of the issue will determine if it is an error, fraud, or abuse.

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Health care services and billing are complicated, which can lead to errors.

Real Life Cases: Medicare Fraud & Abuse in Virginia!

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Three Steps to Prevent Health Care Fraud

1) Prevent

2) Detect

3) Report

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Step 1: Prevent Medicare Fraud and Abuse

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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.

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Step 3: Report Suspected Medicare Fraud and Abuse

✓ Call the provider. ✓ Gather information and documentation. ✓ Contact Virginia SMP.

➢ 1-800-938-8885 ➢ This is a free and confidential service!

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SMP Volunteers

Would you like to: • Help other Medicare beneficiaries prevent,

detect and report? • Community Advocate • Community Educator • Provide one-on-one counseling

18 Join the SMP program as a volunteer!

Contact Virginia SMP

Visit us online: • www.virginiasmp.org • www.facebook.com/virginiasmp

Toll-free: 1 800 938 8885 • To report suspected fraud/abuse • To request a presentation and/or materials • To volunteer with the SMP program

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Questions?

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