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The SMP Program: Protect Yourself from Health Care Fraud

Updated August 2014

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What We Will Cover Today

• The SMP Program

• Examples of Healthcare Fraud

• The SMP Message:

Protect, Detect, Report!

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How much do you think is lost every year to health care fraud and abuse?

A) $5-10 million

B) $25-125 million

C) $10-20 billion

D) $75-250 billion

How Much is Lost?

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How much do you think is lost every year to health care fraud and abuse?

A) $5-10 million

B) $25-125 million

C) $10-20 billion

D) $75-250 billion

How Much is Lost?

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What is Health Care Fraud?

• Billing for services or supplies not provided

• Billing for services or supplies that are different than what was actually provided

• Billing for services or supplies that you do not need

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Why Report Fraud?

People who commit fraud are STEALING from you,

not helping you!

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Why Report Fraud?• When things aren’t ordered by your

doctor, they may not fit or work properly.

• When someone gives you something that you don’t need:• Your health may get worse• Your Medicare benefits may be “used up”

• Your Medicare account may be flagged: “Do Not Pay!”

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Why Report Fraud?• Health care fraud puts you at risk for

identity theft.

• IT’S YOUR MONEY!• Taxpayer dollars• Higher premiums

• Saving the Medicare Program

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The SMP Programwww.illinoissmp.org

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The SMP Program

• Senior Medicare Patrol

• National Program – SMP Programs in all 50 states, Washington,

D.C., Puerto Rico, Guam, Virgin Islands

• Goals of program: – Recruit volunteers to provide outreach– Educate consumers about health care fraud

and abuse

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SMP Staff and Volunteers…• Give presentations to groups (like this one!)

• Share information and materials at health fairs or other events

• Help people with questions about billing mistakes or fraud issues

• Help report fraud to investigators

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Illinois SMP Program Partners

• Illinois Area Agencies on Aging

• Catholic Charities

• White Crane Wellness Center

• Coalition of Limited English Speaking Elderly

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Examples of Health Care Fraud

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Examples of Fraud – Home Health

• A representative from a home health agency in Springfield visited a woman in her home and told her that her doctor wanted the home health agency to check her blood pressure once a week. A nurse came once a week, took her blood pressure, and left. The home health agency billed Medicare for skilled nursing services.

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Examples of Fraud – Durable Medical Equipment (DME)

• A man in Chicago had a stroke and needed an electric wheelchair. When his equipment company tried to bill Medicare for the wheelchair, the claim was rejected because another equipment company had billed Medicare for a wheelchair that they said they gave to him in 2010. This was because a company had fraudulently billed for a wheelchair in his name in 2010.

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Examples of Fraud – Physician Services

A podiatrist in Oak Park trimmed the toenails of multiple residents in a senior building. He then billed Medicare as if he had provided an office visit and foot surgery for each of the residents.

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The SMP Message:

Protect!

Detect!

Report!

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PROTECT Yourself From Fraud!

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PROTECT Yourself From Fraud!

• Do NOT give your Medicare number to people you do not know!– On the phone– At the door– At a presentation, exercise class, screening,

etc. FREE services do NOT require your Medicare number!

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PROTECT Yourself from Fraud!• Don’t carry your Social Security,

Medicare, or Medicaid cards in your wallet!

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PROTECT Yourself from Fraud!• Don’t carry your Social Security,

Medicare, or Medicaid cards in your wallet!– You do not need them in an emergency –

the hospital will treat you, and you can send them your insurance information later

– If you really want to carry something, make a photocopy and black out the last 4 digits of your ID number

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PROTECT Yourself from Fraud!• Shred documents with your personal

information on them BEFORE you throw them away!

• Take the mail out of your mailbox.

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PROTECT Yourself from Fraud!• Do NOT accept services from someone

who calls or visits you unexpectedly, even if they say that your doctor sent them!

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PROTECT Yourself from Fraud!• Do NOT “sign up” for services at a

presentation or event.

• Do NOT sign timesheets or other forms without reading them.

• Do NOT sign blank forms!

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DETECT Fraud!

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DETECT Fraud!• Read your Medicare Summary Notice

or Explanation of Benefits from your insurance company. Watch for:– Services that you did not get– Services that were not ordered by your

doctor– Billing for the same thing twice– Other billing errors

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DETECT Fraud!• Medicare Summary Notices are sent quarterly

(once every three months).

• You can always request a Medicare Summary Notice by calling 1-800-Medicare.

• You can also view your claims and Medicare information online at: www.MyMedicare.gov.

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REPORT Fraud!

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If you notice a mistake:

1. Call the provider. If it is just a mistake, they may be able to fix the problem.

2. If this doesn’t work or you suspect fraud, contact AgeOptions at (800)699-9043.

Report Fraud!

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Volunteers are the key to spreading the SMP message!

We need YOUR help!

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Thank you!

If you have questions, contact:

AgeOptions

(800)699-9043

This presentation was supported in part by a grant (No. 90MP0163 and 90SP0061) from the Administration on Aging (AoA), Administration for Community Living (ACL), U.S. Department of Health and Human Services (DHHS). Grantees carrying out projects under government

sponsorship are encouraged to express freely their findings and conclusions. Therefore, points of view or opinions do not necessarily

represent official AoA, ACL, or DHHS policy.