Innovations of virginias aaa vg co_a - medicare fraud
-
Upload
rexnayee -
Category
Healthcare
-
view
324 -
download
0
Transcript of Innovations of virginias aaa vg co_a - medicare fraud
![Page 1: Innovations of virginias aaa vg co_a - medicare fraud](https://reader031.fdocument.pub/reader031/viewer/2022030307/58e765231a28ab5b2a8b603d/html5/thumbnails/1.jpg)
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
![Page 2: Innovations of virginias aaa vg co_a - medicare fraud](https://reader031.fdocument.pub/reader031/viewer/2022030307/58e765231a28ab5b2a8b603d/html5/thumbnails/2.jpg)
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
![Page 3: Innovations of virginias aaa vg co_a - medicare fraud](https://reader031.fdocument.pub/reader031/viewer/2022030307/58e765231a28ab5b2a8b603d/html5/thumbnails/3.jpg)
Consequences of Medicare Fraud, Errors, and Abuse
3
![Page 4: Innovations of virginias aaa vg co_a - medicare fraud](https://reader031.fdocument.pub/reader031/viewer/2022030307/58e765231a28ab5b2a8b603d/html5/thumbnails/4.jpg)
What is the Senior Medicare Patrol?
4
![Page 5: Innovations of virginias aaa vg co_a - medicare fraud](https://reader031.fdocument.pub/reader031/viewer/2022030307/58e765231a28ab5b2a8b603d/html5/thumbnails/5.jpg)
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
![Page 6: Innovations of virginias aaa vg co_a - medicare fraud](https://reader031.fdocument.pub/reader031/viewer/2022030307/58e765231a28ab5b2a8b603d/html5/thumbnails/6.jpg)
What is Medicare?
6
![Page 7: Innovations of virginias aaa vg co_a - medicare fraud](https://reader031.fdocument.pub/reader031/viewer/2022030307/58e765231a28ab5b2a8b603d/html5/thumbnails/7.jpg)
Parts of Medicare
Medicare Supplement Insurance (Medigap) is not part of Medicare.7
![Page 8: Innovations of virginias aaa vg co_a - medicare fraud](https://reader031.fdocument.pub/reader031/viewer/2022030307/58e765231a28ab5b2a8b603d/html5/thumbnails/8.jpg)
Medicare Numbers and Cards
8
![Page 9: Innovations of virginias aaa vg co_a - medicare fraud](https://reader031.fdocument.pub/reader031/viewer/2022030307/58e765231a28ab5b2a8b603d/html5/thumbnails/9.jpg)
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
![Page 10: Innovations of virginias aaa vg co_a - medicare fraud](https://reader031.fdocument.pub/reader031/viewer/2022030307/58e765231a28ab5b2a8b603d/html5/thumbnails/10.jpg)
What is Medicare Abuse?
10
Providers supply services or products that are not medically necessary or that do not meet professional standards
![Page 11: Innovations of virginias aaa vg co_a - medicare fraud](https://reader031.fdocument.pub/reader031/viewer/2022030307/58e765231a28ab5b2a8b603d/html5/thumbnails/11.jpg)
Examples of Fraud & Abuse
11
![Page 12: Innovations of virginias aaa vg co_a - medicare fraud](https://reader031.fdocument.pub/reader031/viewer/2022030307/58e765231a28ab5b2a8b603d/html5/thumbnails/12.jpg)
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.
![Page 13: Innovations of virginias aaa vg co_a - medicare fraud](https://reader031.fdocument.pub/reader031/viewer/2022030307/58e765231a28ab5b2a8b603d/html5/thumbnails/13.jpg)
Real Life Cases: Medicare Fraud & Abuse in Virginia!
13
![Page 14: Innovations of virginias aaa vg co_a - medicare fraud](https://reader031.fdocument.pub/reader031/viewer/2022030307/58e765231a28ab5b2a8b603d/html5/thumbnails/14.jpg)
Three Steps to Prevent Health Care Fraud
1) Prevent
2) Detect
3) Report
14
![Page 15: Innovations of virginias aaa vg co_a - medicare fraud](https://reader031.fdocument.pub/reader031/viewer/2022030307/58e765231a28ab5b2a8b603d/html5/thumbnails/15.jpg)
Step 1: Prevent Medicare Fraud and Abuse
15
![Page 16: Innovations of virginias aaa vg co_a - medicare fraud](https://reader031.fdocument.pub/reader031/viewer/2022030307/58e765231a28ab5b2a8b603d/html5/thumbnails/16.jpg)
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
![Page 17: Innovations of virginias aaa vg co_a - medicare fraud](https://reader031.fdocument.pub/reader031/viewer/2022030307/58e765231a28ab5b2a8b603d/html5/thumbnails/17.jpg)
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
![Page 18: Innovations of virginias aaa vg co_a - medicare fraud](https://reader031.fdocument.pub/reader031/viewer/2022030307/58e765231a28ab5b2a8b603d/html5/thumbnails/18.jpg)
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!
![Page 19: Innovations of virginias aaa vg co_a - medicare fraud](https://reader031.fdocument.pub/reader031/viewer/2022030307/58e765231a28ab5b2a8b603d/html5/thumbnails/19.jpg)
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
![Page 20: Innovations of virginias aaa vg co_a - medicare fraud](https://reader031.fdocument.pub/reader031/viewer/2022030307/58e765231a28ab5b2a8b603d/html5/thumbnails/20.jpg)
Questions?
20