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.

After that, 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!

The Illinois SMP is here to offer assistance if you feel you have been affected by fraud related to home health care, please call the Illinois SMP at AgeOptions at (800)699-6043.

Please visit www.illinoissmp.org to download the tip sheet above and all of our other tip sheets to help prevent Medicare fraud.

A Pakistani man was recently sentenced to 12 years in federal prison for participating in a home healthcare scheme to bill Medicare for over $40 million in services that were never provided. Muhammad Ateeq, 33, worked in the Islamabad office of Home Health Care Consulting, an entity that controlled Medicare billing and maintenance of electronic medical records for over 20 home health agencies located in Illinois, Indiana, Nevada and Texas. You can read more in this Department of Justice press release here.

The best way to detect fraud is to always read your Medicare Summary Notice or Explanation of Benefits from your insurance company and watch out for services that you did not receive or other billing errors. You have the right to ask your doctor about the services you are receiving. 

If you or someone you know has a been a victim of a potential home health care scam, please call the Illinois SMP Hotline at (800)699-9043.

May and June 2022 Workshops

In-Person Only

May 25^th at 1:30 pm– SMP Basics

Maywood Park District (921 S 9th Ave, Maywood, IL 60153)

May 26^th at 11:30 am – SMP basics

Markam City Hall Building (16310 S. Kedzie, Markham IL 60428)

June 2^nd at 11:00 am – Introduction to SMP with BING0 (Spanish)  

Nuevo Despertar (1820 S 51st Ave, Cicero, IL 60804)

June 7^th at 2:00 pm – Introduction to SMP with BINGO

Cedar Village of Arlington Heights (320 W Campbell St, Arlington Heights, IL 60005)

June 16th at 10:30 am – Introduction to SMP (Spanish)

Summit Public Library District (6233 S Archer Rd, Summit, IL 60501)

June 22nd at 1:30 pm – Introduction to SMP with BINGO

Maywood Park District (921 S 9th Ave, Maywood, IL 60153)

June 23^rd at 10:40 am – Introduction to SMP with BINGO (Spanish)

Mt Carmel Church Meal Site (1101 23rd Ave, Melrose Park, IL 60160)

June 30 at 11:30 am – Types of Medicare Fraud with BINGO

Markham City Hall Building (16310 S. Kedzie, Markham IL 60428)

Hybrid (Zoom and in-person options)

June 3^rd at 10:00 am – SMP How to read your Medicare Summary Notice

Zoom: https://us06web.zoom.us/j/81491217838

In person: Linda Sokol Francis Brookfield Library (3541 Park Ave, Brookfield, IL 60513)

June 10^th , June 17^th and June 24^th at 10:00 am - Introduction to SMP with BINGO

Zoom: https://us06web.zoom.us/j/86508483574

In person: 4565 Harrison St, Hillside, IL 60162

Zoom Only

THRIVE WITH PRIDE: An Inclusive Online Café Presents: 2022 Fraud Update 

May 24^th at 11:00 am

Zoom: https://zoom.us/j/96661294106

Phone: 312-626-6799 Meeting ID: 933 6129 4106#

May 26^th at 2:00 pm – Spanish SMP basics

https://us02web.zoom.us/meeting/register/tZwocu6vrT0iH9WFz2JSaB9234pPZ8CvE47t  Password: awn123 Meeting ID: 885 5773 6851#

June 16th at 6:30 pm – Types of Medicare Fraud

Zoom: https://us06web.zoom.us/j/84316368939  

Phone: 312-626-6799 Meeting ID: 843 1636 8939#