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Medicare Waste, Fraud and Abuse

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

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Medicare Waste, Fraud and Abuse

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  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.

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

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

  13. THANK YOU!

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