Medicare Waste, Fraud and Abuse

1. Medicare Waste, Fraud and Abuse Understand your Medicare statements by using tools to track and organize your healthcare bills.

2. Training Goals • Learn how and why YOU can prevent Medicare waste, fraud, and abuse • See how easy it is to access your claims on MyMedicare.gov • Understand how to read your Medicare Summary Notice

3. 3 steps to preventing Medicare fraud, waste and abuse: • Protect • Detect • Report

4. Step 1: Protect Yourself from Medicare Fraud and Abuse • Do treat your Medicare card and number like your credit cards • Do be aware that Medicare doesn’t call or visit to sell you anything • Don’t give you’re your Medicare number except to your doctor or other Medicare provider • Don’t carry your Medicare card unless you will need it

5. Healthcare Scams • You receive a call from someone offering “free” medical supplies remember : • Once this stranger has your health insurance information, you won’t control what may be done with it; • There is no such thing as “free”; someone is going to be billed, and pay, for the item. • Third party contacts your physician directly, stating you’ve request X; physician approves and you find it on the front porch-may be durable medical equipment, may be prescription medications. You didn’t request it, and either don’t want it or prefer to obtain your own RX, etc.

6. Step 2: Detect Medicare Fraud & Abuse • Use your Personal Health Care Journal • Review Medicare Summary Notices (MSN’s) and other statements • Access your Medicare information at www.MyMedicare.gov

7. Personal Health Care Journal • Take it to appointments • Ask pertinent questions before your appointment • Write down answers to your questions • Write down what happens during your appointment • Use this journal when checking your Medicare and health care paperwork for accuracy • Take this journal with you when you travel

8. www.MyMedicare.gov 1. Users can: • View most recent MSN’S • Check Part B deductible status • View eligibility information • Track available preventative services • Find Medicare health or prescription drug plans

9. Examining the Medicare Summary Notice (MSN) • This is the key tool to help beneficiaries track medical information • Helps beneficiaries to catch errors and potential fraud and abuse

10. The MSN: What to watch for • Look for the same services on different days where one is covered and another is not • Make sure any reimbursement check you receive from Medicare matches what you’re expecting before you cash it • Make sure that you received the services or supplies for which Medicare reimbursed the provider. • Watch for duplicate payments for the same service.

16. Tracking Made Easy Hospital bills, doctor bills, MSN’s, and EOB’s… …Oh My!

17. Step 3: Report it! • Call the provider • Gather information and documentation • Contact your SMP. This is a free and confidential service.

18. THANK YOU!