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Medicare is fighting fraud, abuse

Health care fraud drives up costs for everyone in the health care system and endangers Medicare’s ability to serve future generations. To address this growing problem, the federal government continues to expand efforts to recover improper payments and prevent fraud.

Significant progress in the fight against health care fraud has already been made, as shown by the federal government’s recovery of a record $4 billion last year from people who attempted to defraud seniors and taxpayers. The Affordable Care Act provides additional resources and tools to enable the Centers for Medicare & Medicaid Services to expand efforts to prevent and fight fraud, waste and abuse, including:

  • Creating a rigorous screening process for providers and suppliers enrolling in Medicare to keep fraudulent providers out of the program.

  • Authorizing CMS to temporarily stop enrollment of new providers and suppliers when Medicare spots trends that may indicate health care fraud.

  • Authorizing CMS to temporarily stop payments to providers and suppliers suspected of fraud for investigation and case building.

Fraud prevention efforts focus on moving CMS beyond its former “pay and chase” recovery operations to a more proactive “prevention and detection” model that will help prevent fraud and abuse before payment is made. A good example is the recent CMS announcement that for the first time, through the use of innovative predictive modeling technology similar to that used by credit card companies, the agency will have the ability to use risk scoring techniques to flag high risk claims and providers for additional review and take action to stop payments and remove providers from the program when necessary.

Yet, as important as these aggressive new initiatives are, the first and best line of defense against fraud remains you, the health care consumer.

So here are a few ways you can protect your Medicare benefits:

· Guard your Medicare number. Fraud schemes often depend on crooks first getting hold of people’s Medicare numbers. So treat yours as you would a credit card. Don’t share it with anyone except your doctor or other Medicare-approved health care provider and don’t allow anyone else to use it.

· Look out for suspicious activities. Be wary of salespeople who knock on your door or call you uninvited and try to sell you a product or service. Don’t allow anyone except your doctor or other Medicare-approved provider to review your medical records or recommend services. And never let anyone give you “free” equipment or supplies in exchange for your Medicare number.

· If you have original Medicare, check your Medicare summary notice. Use a calendar or personal journal to record all of your doctor appointments and tests. Then review your quarterly claims statement to make sure Medicare wasn’t billed for something you didn’t get. If you spot what you think is an error, call the doctor’s office or health care provider and ask about it. If they can’t resolve your questions or concerns, call 1-800-MEDICARE.

· Report suspected cases of fraud. If you think someone has misused your Medicare number, call 1-800-MEDICARE. If you suspect identity theft, or feel like you gave your personal information to someone you shouldn’t have, call the Federal Trade Commission’s ID Theft Hotline at 1-877-438-4338.

To learn more about health care fraud and ways to protect against it, visit www.stopmedicarefraud.gov or contact your local senior Medicare patrol project. To find the SMP in your state, go to the SMP Locator at www.smpresource.org. More information about CMS fraud prevention efforts is available at www.cms.gov/Partnerships/04_FraudPreventionToolkit.asp.

—U.S. Department of Health

and Human Services

Hunting for a prescription drug plan is no game

It’s that time of year again.

“Open season” is right around the corner for the Medicare Part D prescription drug plan. Hunting down the best plan for you is no game. Newly eligible Medicare beneficiaries, and current beneficiaries who are considering changes to their Medicare Part D plan, should mark their calendars for Saturday, Oct. 15. The “open season” will run from Oct. 15 to Dec. 7.

The Medicare Part D prescription drug program is available to all Medicare beneficiaries to help with the costs of medications. Joining a Medicare prescription drug plan is voluntary, and participants pay an additional monthly premium for the coverage.

While all Medicare beneficiaries can participate in the prescription drug program, some people with limited income and resources also are eligible for “Extra Help” to pay for monthly premiums, annual deductibles and prescription co-payments. The Extra Help is worth about $4,000 a year.

To figure out whether you are eligible for the Extra Help, Social Security needs to know your income and the value of any savings, investments, and real estate (other than the home you live in). To qualify, you must be receiving Medicare and have income not greater than $16,335 for an individual or $22,065 for a married couple living together. Even if your annual income is higher, you still may be able to get some help with monthly premiums, annual deductibles and prescription co-payments. Some examples where your income may be higher include if you or your spouse:

— Support other family members who live with you;

— Have earnings from work; or

— Live in Alaska or Hawaii; and

— Resources not more than $12,640 for an individual or $25,260 for a married couple living together.

Resources include such things as bank accounts, stocks and bonds. We do not count your house or car as resources.

You can complete an easy-to-use online application for Extra Help at www.socialsecurity.gov. Go to the Medicare tab on the top of the page. Then go to “Apply For Extra Help With Medicare Prescription Plan Costs.” To apply for the Extra Help by phone or have an application mailed to you, call Social Security at 1-800-772-1213 (TTY 1-800-325-0778) and ask for the Application for Extra Help with Medicare Prescription Drug Plan Costs (SSA-1020).

And if you would like more information about the Medicare Part D Prescription Drug Program itself, visit www.medicare.gov or call 1-800-MEDICARE (1-800-633-4227; TTY 1-877-486-2048).

So this open season (Oct. 15-Dec. 7), after you track down the perfect prescription drug plan for you, hunt for something that could put about $4,000 in your pocket — bag the best Medicare prescription drug plan for you and see if you qualify for the Extra Help through Social Security.

—Blanca Taylor

Social Security Public Affairs Specialist