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Innovations of virginias aaa vg co_a - medicare fraud

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Innovations of virginias aaa vg co_a - medicare fraud

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Innovations of virginias aaa vg co_a - medicare fraud

  1. 1. 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
  2. 2. Medicare Fraud, Errors, and Abuse Affect… 2 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
  3. 3. Consequences of Medicare Fraud, Errors, and Abuse 3
  4. 4. What is the Senior Medicare Patrol? 4
  5. 5. 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. 5
  6. 6. What is Medicare? 6
  7. 7. Parts of Medicare Medicare Supplement Insurance (Medigap) is not part of Medicare. 7
  8. 8. Medicare Numbers and Cards 8
  9. 9. 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 9
  10. 10. What is Medicare Abuse? 10 Providers supply services or products that are not medically necessary or that do not meet professional standards
  11. 11. Examples of Fraud & Abuse 11
  12. 12. What about Errors? Only a review and investigation of the issue will determine if it is an error, fraud, or abuse. 12 Health care services and billing are complicated, which can lead to errors.
  13. 13. Real Life Cases: Medicare Fraud & Abuse in Virginia! 13
  14. 14. Three Steps to Prevent Health Care Fraud 1) Prevent 2) Detect 3) Report 14
  15. 15. Step 1: Prevent Medicare Fraud and Abuse 15
  16. 16. 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. 16
  17. 17. 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! 17
  18. 18. 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!
  19. 19. 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 19
  20. 20. Questions? 20

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