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Medicare Fraud. How We Can Fight it.

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Today we bring you a blog post from guest blogger and NJFA friend Charles Clarkson, Project Director of the Senior Medicare Patrol of New Jersey.

By Charles Clarkson, Project Director, Senior Medicare Patrol of NJ

 

Medicare fraud is estimated to cost American taxpayers $60 billion a year, monies that are siphoned off and are not available for legitimate Medicare services. At the Senior Medicare Patrol of NJ (SMP), which is a federally funded program, we want to educate Medicare beneficiaries so they do not become victims of Medicare fraud. There are steps Medicare beneficiaries can take to fight this fraud. The most important step is to protect your Medicare number. Even though Medicare issued new Medicare cards to all beneficiaries with randomly generated numbers and letters and removed the social security number from the cards, the Medicare number (now known as the Medicare Beneficiary Identifier) is still very valuable to fraudsters who can use it to bill Medicare. Beneficiaries should not give out their Medicare numbers to anyone they don’t trust. This is especially true for the many beneficiaries who receive robo calls on a constant basis. The rule of thumb is to never pick up the phone if you do not recognize the telephone number on your message machine. Let the message machine screen all of your calls and then you can decide to return the call or not. Most beneficiaries will find that no message is left and they can then ignore the call.

The next step is to always read your Medicare Summary Notice (MSN), the document a beneficiary receives from Medicare usually 3 months after seeing a Medicare provider. It is important for beneficiaries to review their MSN, not just because of fraud but because mistakes can also happen.

Step three is to keep a personal health care journal or calendar. Record every time you see a medical provider, take a test or have other services provided. When you get your MSN compare it with your journal or calendar. Make sure you are not being scammed. If you are not sure something is fraud or you have a question about the billing, call your provider and ask for an explanation.

Step four is to report any suspected fraud or error. This step is vitally important. Failure to report will translate into the provider getting away with any fraud or errors. Remember, this is your money. You pay Medicare premiums, co-pays, co-insurance, deductibles and other charges. If you need assistance in fighting Medicare fraud, as you were unable to resolve it yourself, call the SMP. Our telephone number is 732-777-1940 and our hot-line number if 877-SMP-4359. A beneficiary can also use our web-site to report a fraud on the form provided. Visit seniormedicarepatrolnj.org

Even if you are not sure if it is fraud but need questions answered, call us. We are a free service and we are here to help. Every beneficiary should feel empowered to help fight Medicare fraud. At the SMP we want to keep Medicare as a viable program that is there for every beneficiary.

Charles Clarkson is Project Director of the Senior Medicare Patrol of NJ

The New Medicare Cards

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The New Medicare Cards

By Charles Clarkson, Project Director, Senior Medicare Patrol of New Jersey

In 2015, Congress passed the Medicare Access and CHIP Reauthorization Act. This law requires the removal of the social security numbers from all Medicare cards by April 2019. This new initiative is referred to as the Social Security Number Removal Initiative (SSNRI.) A new randomly generated Medicare Beneficiary Identifier (MBI) will replace the social security number. When the initiative gets underway all Medicare beneficiaries will be assigned a new MBI and be sent a new Medicare card.

The primary goal of the initiative is to decrease Medicare beneficiaries’ vulnerability to identity theft by removing the social security number from their Medicare cards and replacing it with a new Medicare MBI which does not contain any other personal information.

The new MBI will have the following characteristics:

i. The same number of characters as the current Medicare number, but will be visibly distinguishable from the Medicare number

ii. Contain uppercase alphabetic and numeric characters throughout the new MBI

iii. For providers, the new MBI will occupy the same field as the Medicare number on transactions

iv. Be unique to each beneficiary (e.g. husband and wife will have their own MBI)

v. Be easy to read and limit the possibility of letters being interpreted as numbers (e.g. alphabetic characters are upper case only and will exclude S, L, O, I, B, Z)

vi. Not contain any embedded intelligence or special characters

vii. Not contain inappropriate combinations of numbers or strings that may be offensive

The Centers for Medicare and Medicaid Services (CMS), the agency that oversees Medicare, has established a transition period during which the Medicare number or MBI will be accepted from providers, beneficiaries, plans, and others. CMS expects the transition period to run from April 2018 through December 31, 2019. After the transition period only the MBI will be used.

Starting around April 2018, CMS will start mailing new Medicare cards. There are approximately 60 million beneficiaries in Medicare. So, CMS will probably mail the cards in phases over a period of time. Remember, as a beneficiary you can still use your current Medicare number during the transition period if it takes awhile to receive your new Medicare card. If a beneficiary is new to Medicare after April 2018 and Medicare has started issuing the new cards, the beneficiary will receive the new MBI. Therefore, healthcare providers must be able accept the new MBIs by April 2018.

Fraud and the new Medicare cards.

The Senior Medicare Patrol of New Jersey (SMP) wants all Medicare beneficiaries to be aware of possible fraud and scams relating to the new Medicare cards. Remember, CMS and Medicare will never contact you by phone or email to ask for personal information relating to the issuance of the new Medicare cards. Any such contact is a scam. Don’t be taken in. Also, there will be no charge for the issuance of the new Medicare cards. Anyone seeking to have a beneficiary pay money for the new card is a scammer. Be especially careful of anyone seeking to have access to your checking account to pay any fee for the new card. Beneficiaries are especially vulnerable if they are isolated, frail or may have cognitive loss. Caregivers should be on the alert for these kinds of scams. The SMP is currently educating beneficiaries at its outreach events of the issuance of the new Medicare cards. CMS will also be conducting intensive education and outreach to beneficiaries to help them prepare for this change.

The issuance of the new Medicare card is a significant change. If a beneficiary or caregiver has any questions about the SSNRI, please don’t hesitate to call the SMP at 1-877-SMP-4359 (1-877-767-4359) or 732-777-1940. A beneficiary or caregiver can also email me at charlesc@jfsmiddlesex.org.

New Rules for Durable Medical Equipment in New Jersey

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New Rules for Durable Medical Equipment in New Jersey

If you are a beneficiary with Original Medicare (a person who has Parts A and B of Medicare and not a Medicare Advantage plan) who uses  or plans to use certain durable medical equipment and supplies, such as oxygen, walkers, or wheelchairs, you should know about the new rules that started on July 1, 2013 in New Jersey.  The Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program is an attempt to save money for taxpayers and people with Medicare and may change the suppliers people with Medicare will need to use.

Most counties and zip codes in New Jersey will now be a part of this competitive bidding program.  You can check if your zip code is in a competitive bidding are by going to a fact sheet at http://www.cms.gov/Outreach-and Education/Outreach/Partnerships/Downloads/DMEPOSBeneFactSheetMarch2013.pdf. 

As of July 1, people with Original Medicare who live in or travel to one of these areas and need the items listed below will need to get these items from an approved contract supplier if they want Medicare to cover these supplies, unless their current suppliers decide to become grandfathered suppliers (non-contract suppliers that choose to continue to provide certain rented medical equipment or oxygen under the terms of the program). 

Beneficiaries will need to find out which suppliers are Medicare contract suppliers to make sure Medicare will  pay for their medical equipment or supplies. You can find out if a supplier is a contract supplier for the program by visiting http://www.medicare.gov/supplierdirectory/search.html or by calling 1-800-MEDICARE (1-800-633-4227). 

The competitive bidding program will only cover certain categories of products.  The 8 product categories that are included in the program are:

1.         Oxygen, oxygen equipment, and supplies;

2.         Standard (power and manual) wheelchairs, scooters, and related  accessories;

3.         Enteral nutrients, equipment, and supplies;

4.         Continuous Positive Airway Pressure (CPAP) devices, Respiratory Assist Devices (RADs) and related supplies and accessories;

5.         Hospital beds and related accessories;

6.         Walkers and related accessories;

7.         Support surfaces (Group 2 mattresses and overlays); and

8.         Negative Pressure Wound Therapy pumps and related supplies and accessories.

In addition to the categories of items listed, Medicare will be starting a national mail-order program for diabetic testing supplies at the same time.  The national mail-order program will include all parts of the United States, including the 50 States, the District of Columbia, Puerto Rico, the US Virgin Islands, Guam, and American Samoa.  With this national mail-order program, people with Original Medicare will need to use a contract supplier for diabetic testing supplies delivered to their homes.  If these supplies are not delivered to a beneficiary’s  home, a beneficiary can go to any retailer that provides these supplies, but they may pay more. 

To assist beneficiaries, Medicare mailed information to people in the competitive bidding areas who use the items included in the program, in addition to those who use diabetic testing supplies across the country.  Approximately 5.7 million people with Medicare have been sent a letter and information.  You can review the letters, introductory brochure, national mail-order program fact sheet and other program education materials by visiting http://www.cms.gov/Outreach-and-Education/Outreach/Partnerships/DMEPOS_Toolkit.html.

Should you have any questions, please contact the Senior Medicare Patrol of New Jersey at 732-777-1940.  You can also contact the State Health Insurance Assistance Program (SHIP) at 1-800-792-8820.