SMP Volunteer Training Virginia Department for the Aging

SHIP-VICAP Training

The Virginia Association ofArea Agencies on Aging April 2009

SMP Background

The SMP project is a consumer education and information program.

Volunteers are recruited and trained to provide presentations and outreach regarding Medicare / Medicaid fraud, waste and error

The Administration on Aging (AOA) funds and administer grants to 59 community-based projects

Virginia SMP

In Virginia, The Virginia Association of Area Agencies on Aging (V4A) has operated the SMP Program for 10 years

Virginia SMP partners with the 22 Area Agencies on Aging (the Aging Network) throughout the state of Virginia. Both AAA staff and volunteers help in most all planning and service areas. Local Area Agencies on Aging partners assist us with local grant objectives. This year, we set out to disseminate 80,000 healthcare fraud prevention toolkits to help educate beneficiaries and prevent fraud.

Other partners include: Office of the Inspector General, Virginia Department of Medical Services, Centers for Medicare & Medicaid Services, Virginia Department for the Aging, Department of Justice, CMS Contractors, Office of the Attorney General – Medicaid Fraud Control Unit, SeniorNavigator, Virginia Insurance Commission, Virginia Department of Health, TRIAD, and many health & aging state and community-based organizations

Why Should We Care ??

Each year Medicare and Medicaid lose BILLIONS to error, fraud, and abuse.

Health care fraud is not just about the government or someone else losing money.

People can get sick, lose benefits, lose money, and get stuck with bad equipment or other items they don’t need.

99% of health care providers are honest. However, by some estimates, those bilking the system are collecting approximately 10% of ALL Medicare and Medicaid payments.

Why Partner with Virginia SHIP/VICAP?

Both organizations are in the Virginia “Aging Network”

Both share the AAA’s as partners Both share other health, aging and

consumer partners as well Desired program outcomes for volunteers,

staff time, training and community education and awareness

Some AAA’s share staff and volunteers

Informal Partnership Benefits

Growth potential Staff and volunteers more knowledgeable Save staff time, and volunteer efforts SMP – is about prevention and education –

why duplicate advertising and funds? SMP will try and help achieve goals and could help AAA achieve VICAP goals

When Should We Suspect a Potential Scam or Fraud & Abuse?

Offers of “free” services or equipment in exchange for Medicare Numbers

Billings for Services or Equipment never provided

Medicare patients billed at a higher rate than non-Medicare patients

Submitting bills to Medicare when Medicare is not the Primary Insurer

Incorrect dates of Service Waiving Co-Payments

Some Common Health Care Schemes

Home Health – billing for services not provided. Billing for more services than provided.

Kickbacks offered-(cash or benefits) Up coding Not quite eligible –clients or staff Agencies with ties to companies

Common Schemes; Continued

Unnecessary items or equipment (scooters, wheelchairs)

With Durable Medical Equipment, Consumers may not be able to use the quantity received

Vast Quantities of Supplies Supplier conducts health screenings and medical

surveys to obtain numbers. Business generated by telemarketing or “free” offers

Examples of Fraud in Nursing Homes & Hospitals

Severely dehydrated and neglected residents may indicate neglect of services being billed to Medicare

Large supply of kits – marked for some residents and used for others

Therapies-being provided for groups of patients or not provided individually

Patient files – protection The same medical equipment for every patient –

(unlikely all patients need or uses the same brand and type of equipment)

Other Examples; Continued

Misrepresentation of patient’s condition or claim for to increase payment

Billing for multiple x-rays when one was taken Some patients may be incapable of reviewing and

understanding bills and services Labs – adding tests not ordered and rolling labs,

diagnostic tests not medically necessary Some ambulance services – miles, need

Medicare Part D – Examples of Potential Scams

Individual or Organization pretends to be associated with Medicare or Social Security to steal beneficiaries’ $$ or identity

Beneficiaries selling drugs or ID cards for $$ or using someone else’s card

Plan activities – Cherry picking / discrimination to enroll healthier beneficiaries

Offering cash or gifts to enroll Billing for drugs not received Double billing beneficiaries for premiums Prescription shorting or illegal substitution Altering beneficiaries’ co-pay amounts to get through the

coverage gap

We Teach Others How to Protect Themselves

Know Your Medications Pay Attention to Packaging Only Buy Prescription Medications

From a Safe, Reliable Source If you buy medications online, make

sure the seller is properly licensed If you believe you have bought a

counterfeit drug, report it

Teaching Others to Protect Themselves; Continued

Check for billing errors prior to leaving the place of service Medicare Number correct ? Correct Name? Keep personal information from falling into the wrong hands.

Protect your number like a bank account number Remember Medicare does not go Door-to Door Take your Social Security Number off your Driver’s License

and Checks! Compare Bills with your Medicare Summary Notice and ask: Did I receive the service or product? Did my Doctor order the service or product? Is the product or service relevant to what I was treated for?

Teaching Others to Be Their Own Advocate

Remember, Knowledge is Power! Know what kind of health plan you have (Rules and how to

use you insurance) Understand what you are signing and what your

responsibilities are Communicate with your doctors about your needs and wishes Communicate with your health insurance provider about

coverage Know how to read your bills and statements Know where to turn for help in getting questions answered

and resolving problems Be a Resourceful Consumer

What to Do if You Suspect Waste, Fraud or Abuse

Phone the Provider Phone the Insurance Company Call Medicare Concerns Line or HHS Call Virginia SMP Hotline: 1-800-938-8885

In Richmond – 804-644-5628

Senior Medicare Patrol en Espanola

How Can You Help?

You have by your participation in this training! You can help us do one of the following:

Help the V4A distribute healthcare fraud prevention toolkits in your local community to targeted groups of seniors and organizations. Time period between October 2009 – February 2010).

Provide volunteer assistance with community education or community awareness activities.

Include a fraud segment or handout with your VICAP education and assistance program.

Report your efforts!!

SMP Accomplishments

It is difficult to accurately calculate the saving attributable to the prevention of errors, fraud, waste and abuse by the more than 1.9 million seniors who have participated in group sessions or received one-on-one counseling from their local SMP volunteer.

The Office of the Inspector General’s most recent outcomes tracking report of the SMP program indicates that since inception, the program has documented savings of more than $104 million.

In Virginia – June 2008-March 2009

Estimated number of media outreach activities -32,697 cable spots, radio and newspaper ads in hometown newspapers and press releases all over the Commonwealth.

Total number of Volunteers – 83.

Number of Group Education events conducted for beneficiaries - 118

Estimated number of community presentations, exhibits, or one-on-one sessions throughout Virginia -96.

8,230 - Estimated number of beneficiaries reached by community outreach education events.