Fraud in the News
The following are current news articles about health care and fraud issues.
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This project was supported, in part by grant number 90MP0216, from the U.S. Administration for Community Living, Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official Administration for Community Living policy.
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Dear SMP Readers,
In this week's Fraud Alert, a new tip sheet about home health care and the Fall Open Enrollment Period.
Have a great weekend!
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Are Those Services Really Necessary?
New Home Health SMP Tip Sheet
The phone rings and the caller tells you that she "works with Medicare." She tells you that she wants to ensure you are receiving all the benefits to which you are entitled. Therefore, she asks you if you would like to have a doctor come to your home once a month, a nurse to check on you once a week, and an aide to do some light housekeeping and a little shopping every few weeks. All she needs to do is confirm that you have Medicare, and then the services will be free of charge. Sound too good to be true? Well, it is! That is not the way Medicare works.
That so-called Medicare representative may schedule appointments for people to go into your home to maybe take your vitals (blood pressure, temperature, heart rate) or fill your pill box. The company then bills your Medicare account thousands of dollars for skilled care. However, these type of services in the home are not covered by Medicare, because they are not skilled services, and they were not ordered by your doctor.
Home health care is a variety of services given in the home for an illness or injury and most often is ordered for a patient after a hospital stay. In order for Medicare to cover home health care, all of the following criteria must be met:
- Services must be ordered by your doctor
- You must be certified homebound by a doctor
- You must need skilled care
- You must have a written plan of care
A phone call from a stranger offering health care services in the home does not meet any of the above criteria. A stranger does not know you or your health history and certainly cannot diagnosis your needs over the phone. Always work with your doctor for your health care needs. The Illinois SMP suggests that if you receive a phone call from an unknown person offering free home health care services to just hang up.
You can read more information about how to prevent home health care fraud in our brand new Illinois SMP tip sheet.
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Medicare Open Enrollment Period:
Ask the Right Questions
The
The Medicare open enrollment period is just around the corner; it happens each year between October 15 and December 7. This is the time of year when you can change your Medicare coverage (your Part D or Medicare Advantage plan), and any changes you make will go into effect on January 1, 2018.
It is recommended to review your Medicare coverage annually to make sure it still meets your needs. Will your providers still be in the plan's network? Will your medications still be on the plan's formulary? This is the time to re-evaluate your out-of-pocket costs, such as monthly premiums, deductibles and co-pays. You can compare plans during Open Enrollment to see what plan will best meet your needs.
Be careful, however, because this is also a time when dishonest insurance agents are looking to make money and enroll people in plans that are not the best choice for them. The Illinois SMP tool, "
Ask the Right Questions
," can help you prepare for talking to an insurance agent. You can also read the new
Spanish version here.
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