UPDATES FROM FALLON HEALTH |
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WBJ webcast
How the pandemic is changing health care
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Fallon Health is proud to be the presenting sponsor for this important discussion, which will feature Donald M. Berwick, M.D., M.P.P., as keynote speaker. Dr. Berwick is President Emeritus and Senior Fellow at the Institute for Healthcare Improvement and former administrator of the Centers for Medicare & Medicaid Services.
Carolyn Langer, M.D., Fallon’s Senior Vice President and Chief Medical Officer, will be part of a panel of experts for a discussion of topics such as:
- Changes in health care delivery models during the pandemic. What lessons have been learned? How is health care delivery likely to evolve after the pandemic?
- Public policies that the crisis has shown to be broken and in need of repair.
- New models for delivering affordable, quality care.
- How the outcome of the November election may affect the health care industry.
- Behavioral health during the pandemic. What funding and new models of service delivery are needed?
- How COVID-19 has changed health and wellness responsibilities for employers and employees.
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Deadline approaching
Plans for retirees
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If you have clients with employees who are nearing retirement or are already eligible for a Medicare plan, you can help them make informed choices during Medicare's Annual Election Period (AEP), which continues only until this Monday, Dec. 7.
Because we know that Medicare is complicated, Fallon Health is offering comprehensive Medicare presentations that are available to all via live Zoom meetings or prerecorded presentations.
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Help fight fraud, waste and abuse |
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At Fallon Health, we work hard to prevent fraud, waste and abuse (FWA). FWA hurts everyone. In addition to causing premiums and out-of-pocket costs to go up, FWA can compromise health and safety, which in turn can harm patients and undermine the public’s confidence in the health care system. Health care fraud is defined as intentionally deceiving, lying or misrepresenting a situation, knowing that a member or someone else could get an unauthorized benefit as a result. You can learn more by reading Fallon's fraud, waste and abuse policy for examples.
Since February 2020, Fallon has partnered with Cotiviti, Inc., a leader in combating FWA. Cotiviti’s integrated solution combines data analysis, decisions and insights with rules and algorithms to create a dynamic FWA solution.
Report suspected fraud
Always contact us for help if you’re uncertain or suspicious about a situation. If you or one of your employees suspect fraud and wish to report it anonymously, call our toll-free anonymous hotline at 1-888-203-5295 (TRS 711) (24 hours per day/seven days per week).
If you prefer to identify yourself, you can call our Customer Service number (listed on the back of Fallon ID cards) to report an incident.
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How we protect private information |
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You want to keep your employees’ health information private—and so do we. In fact, the Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires us to safeguard members’ protected health information (PHI), whether printed, electronic or oral.
The law has strict guidelines to keep PHI—such as a member’s name and medical treatment—private and confidential. Fallon uses PHI for purposes of treatment, payment and health plan operations.
Protecting personal information is the best line of defense in the fight against identity theft, as well as health care fraud and abuse. Social Security numbers should be treated like credit card numbers and not shared. Membership cards for Fallon Health and other insurance must also be protected, because they contain information about benefits.
Please call 1-888-203-5295 in the event of a privacy concern. This toll-free anonymous hotline is available to you and your employees 24 hours per day/seven days per week.
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COVID-19 resources: Testing options |
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Fallon covers COVID-19 diagnostic testing, based on CDC and other regulatory guidance, for members who are in one of the following three categories:
- A health care provider has identified the individual as having COVID-19 related symptoms.
- A local Board of Health, the Massachusetts Department of Public Health, the Community Tracing Collaborative or a health care provider has determined that the individual has been in close contact with someone confirmed or clinically diagnosed with COVID-19.
- An individual is admitted to a health care facility, such as a hospital or skilled nursing facility.
Testing solely to meet back-to-work/school COVID-19 testing requirements is not covered, unless it’s deemed medically necessary by a provider.
The state of Massachusetts is running a strategic testing program called Stop the Spread, which is providing free testing in certain cities and towns. Asymptomatic individuals may be tested at these sites, even if they don’t reside in the particular city or town. The Massachusetts Emergency Management Agency’s COVID-19 Test Site Locator provides information on additional testing locations.
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Health and wellness
Information you can use and share
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