What Can YOU Do to Prevent Healthcare Fraud?

Sponsored by: Idaho Commission on Aging Senior Medicare Patrol Program

Presented by: (Presenter name, SMP agency name)

Funded by: US Administration on Aging

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

Billing for services, supplies or equipment that were not provided

Obtaining or giving a Medicare number for “free” services

Claims for services that are not medically necessary

Using another person’s Medicare number, or letting someone else use your number, to obtain medical care, supplies or equipment

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Medicare Fraud, Errors, and Abuse Affect…

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EveryoneBillions of taxpayer dollars

lost to improper claimsMedicare trust fund at risk

Medicare BeneficiariesHigher premiumsLess money for needed

benefitsQuality of treatment

Three Steps to Prevent Health Care Fraud

1) Protect

2) Detect

3) Report

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Step 1: Protect Yourself from 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 your SMP/SHIBA. This is a free and confidential service!

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SMP Volunteers

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

detect and report?• Give presentations? (like this one!)• Provide one-on-one counseling?• Perform administrative work?

10Join the SMP/SHIBA program as

volunteer!

Contact your State SMP/SHIBA:

Senior Medicare Patrol and Senior Health Insurance Benefits Advisors

Visit us online: http://www.doi.idaho.gov/shiba/shwelcome.aspx

Call Toll-free: 1-800-247-4422

• To report suspected fraud/abuse

Call : (your agency phone #)

• For training, speakers, and/or materials

• To volunteer with the SMP and SHIBA programs11