BrattleboroCitizens'Breakfast

October24,2014
GibsonAikenCenterBrattleboroVT

MedicareFacts&MedicareFraud

Presenter:KellyMcElheny,
CommunityofVermontEldersC.O.V.E./SMP
SouthernVTVolunteerandOutreachCoordinator
Kelly@vermontelders.orghttp://www.vermontelders.org/wordpress/smp

SMP(formerlySeniorMedicarePatrol)isaprogramthatexistsinall50statesandisfundedbytheUS
AdministrationonAgingtoempowerseniorstoprotectthemselvesagainstMedicareerrors,fraudor
abuse.Since2003,C.O.V.E.hasbeenthesponsoringagency,administeringthefederalgrant.Anita
Hoy<Anita@vermontelders.org>istheDirectorwhoalsocoverstheterritorynorthofRte.4/White
RiverJunction,whileKellyMcElhenycoversthesouthernpartofthestate.

Thismaterialisalsorelevanttothosepersonsundertheageof65whoaredisabled,onMedicareand
whomaybedualeligibles.

ThebrochureDontBeaTargetofHealthcareFraudgetsthemessageacrossifyoususpect
errors,fraudorabuse,reportit!Bydoingso,youwillsaveyourbenefitsandhelpprotectothers.Evenif
youreceiveabenignphonecall,SMPwantstoknowwhatisgoingon.SMPcanmakeadirectreferral
totheConsumerAssistanceProgram(CAP)oftheVermontAttorneyGeneralsOffice,ifthematterfalls
withinthatprogramsscope.FindotherReferralContactshere.

Somescams,suchascompletedwiretransfers,cannotbereversed.However,CAPdoesworkwith
WesternUniontostopfraudulentwiretransfersbeforetheyoccur.Investigationscanalsolinkinthe
OfficeoftheInspectorGeneralandthroughthem,theFBI.

AninvestigationresultinginafederalprosecutioninvolvedtheScooterStore,effectivelyshuttingdown
thebusinesswhichwasresponsibleforsome$50millioninMedicarefraud.Thescooterswere
advertisedas"free"tobeneficiaries,billedtoMedicare,leavingseniorstopaythe20%underPartB,
therebyowingasmuchas$10,000.Takingthescooteroutside,whereitwouldbemostneeded,voided
thewarranty. Theindustryresponsehasbeentonowrentscootersinstead.
1

C.O.V.E.,thesponsoringagencyforSMP,hasanumberoflegislativeagendaitemsincluding:

LIHEAPlowincomeheatingassistance
TransportationadvocatingforfundingElderly&Disabledtransportationservices($600,000was
allocatedstatewidein2013)
Kinshipcaregivingenablinggrandparentstohavemorerights/ofasayinraisinggrandkids
1
"TheSCOOTERStoreshuttingdownafterfederalscrutiny,CBSprobe,"CBSNews,September14,2013
http://www.cbsnews.com/news/thescooterstoreshuttingdownafterfederalscrutinycbsprobe/

InformationaboutjoiningC.O.V.E.canbefoundhere.

TipsonprotectingyourselffromMedicarefraudinclude:
ProtectingyourMedicarenumberlikeyourSocialSecuritynumber
Usingtheprescriptiondrugdropoffsitesforunwantedmedications.Stayingontopofunwanted
medspreventsthemfrombeingabusedbyfamilymembersand/orcaregivers.see:Drug
DiversioninVermont:WhenHealingHandsHarm"

TheOpenEnrollmentperiodforMedicareAdvantageandprescription(PartD)coveragerunsfrom
October15toDecember7,2014.ReadtheAnnualNoticeofChangetofindoutifyourmedications
arestilllistedintheplan.Itisunfortunate,butsomemedicationscanbedroppedfromplansduringthe
yearwithonly10daysnotice.

AresourcefordealingwithPartDissuesistheSHIPCoordinatorSharonO'Neillin
Springfield,VT18028856636or8666738376http://www.medicarehelpvt.net/aaa.html

OnthesecondWednesdayofthemonth,thenextdatebeingNovember12,Kellygivescurrent
informationduringtheMedicareMinuteatlunchhouratBrattleboroSeniorMeals.

OnepieceofadviceduringopenenrollmentistobewareofThirdClass(nowStandard)mail
advertising.Donotsendbacktherequestforinformationcardscontainedinthemailings.Doingso
allowsthecompaniestosolicitbusinesstheywouldnototherwisebelegallyallowedtodo.

AnalysingtheMedicareSummaryNoticewillhelptoidentifyerror,fraudandabuse.Billingerrorsor
deniedchargesusuallyinvolveahealthcareproviderusinganincorrectcodewaituntiltheerroris
correctedandreconciledbeforepayingthebill.Ifthesituationcontinues,theremaybeabuseandifitis
repetitiousacrosspatients,mayindicatefraud.SMPdoesnothavetoprovefraudinordertoreportit.
Theruleis:ifyoususpectfraudreportit!SMPislookingforvolunteerstoworkpeertopeerto
detectandreportfraud.

ThosenewtoMedicareshouldreviewp.61ofthe2015Medicare&Youbooklet,availableonlineat
http://www.medicare.gov/,whichlists23freepreventativeserviceswhichcanbeincludedaspartofa
physicalorwellnessvisit.Also,thisyear,folksshouldbeawarethatAARPdroppedtwoofitsMedicare
Advantageplans,leavingonlytwoplans.

TheHealthCareAdvocatemaybeabletohelpwithhealthinsuranceissuesthatcannotberesolvedby
SHIPandVermontLegalAidoffershelpwithAdvanceDirectives.

VermontSMPhasseveralinterestingprogramstosharewiththecommunityincludingtheSavvy
SeniorsPerformancesandexploringwaystobringotherresourcestothecommunitywiththehelpof
theBrattleboroTimetrade.