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The SMP Program
Empower Your Clients to Prevent Health Care Fraud in Your State
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What We Will Cover Today
• The SMP Program
• What is Health Care Fraud?
• The SMP Message:
Protect, Detect, Report!
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The SMP Programwww.smpresource.org
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The SMP Program
• Senior Medicare Patrol
• National Program – SMP Programs in all 50 states, Washington,
D.C., Puerto Rico, Guam, Virgin Islands
• Goals of program: – Recruit volunteers to provide outreach– Educate consumers about health care fraud
and abuse
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SMP Staff and Volunteers…• Share fraud prevention tips with consumers
with presentations, information at health fairs, etc.
• Help people with questions about billing mistakes or fraud issues
• If needed, help report fraud to investigators
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What is Health Care Fraud?
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What is Health Care Fraud?
• Billing for services or supplies not provided
• Billing for services or supplies that are different than what was actually provided
• Billing for services or supplies that you do not need (i.e., not medically necessary)
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Why Report Fraud?• When things aren’t ordered by your
doctor, they may not fit or work properly.
• When someone gives you something that you do not need, your health may get worse.
• Your Medicare benefits may be “used up” and you may be denied when you need it.
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Examples of Fraud – Home Health
• A representative from a home health agency in Springfield visited a woman in her home and told her that her doctor wanted the home health agency to check her blood pressure once a week. A nurse came once a week, took her blood pressure, and left. The home health agency billed Medicare for skilled nursing services.
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Examples of Fraud – Durable Medical Equipment (DME)
• A man in Chicago had a stroke and needed an electric wheelchair. When his equipment company tried to bill Medicare for the wheelchair, the claim was rejected because another equipment company had billed Medicare for a wheelchair that they said they gave to him in 2010. This was because a company had fraudulently billed for a wheelchair in his name in 2010.
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Examples of Fraud – Physician Services
A podiatrist in Oak Park trimmed the toenails of multiple residents in a senior building. He then billed Medicare as if he had provided an office visit and foot surgery for each of the residents.
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The SMP Message:
Protect!
Detect!
Report!
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PROTECT Yourself From Fraud!
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PROTECT Yourself From Fraud!
• Do NOT give your Medicare number to people you do not know!– On the phone– At the door– At a presentation, exercise class, screening,
etc. FREE services do NOT require your Medicare number!
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PROTECT Yourself from Fraud!• Always work with your doctor – only
your doctor knows what care you need.
• People calling on the phone offering services are not your doctor.
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DETECT Fraud!
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DETECT Fraud!• Read your Medicare Summary Notice
or Explanation of Benefits from your insurance company. Watch for:– Services you never received
– Services different from what you received
– Services that were not ordered by your doctor (not medically necessary)
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DETECT Fraud!• Medicare Summary Notices are sent quarterly
(once every three months).
• You can always request a Medicare Summary Notice by calling 1-800-Medicare.
• You can also view your claims and Medicare information online at: www.MyMedicare.gov.
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REPORT Fraud!
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If you notice a mistake:
1. Call the provider. If it is just a mistake, they may be able to fix the problem.
2. If this doesn’t work or you suspect fraud, contact your local SMP.
Report Fraud!
If you are in Illinois…
AgeOptions hosts the Illinois SMP(800)699-9043
www.illinoissmp.org
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Volunteers are the key to spreading the SMP message!
We need YOUR help!
Since 1974, AgeOptions has established a national reputation for meeting the needs, wants and expectations of older adults in suburban Cook County. We are recognized as a leader in developing and helping to deliver innovative community-based resources and options to the evolving, diverse communities we serve.
Thank you!
Find your state’s SMP at:
www.smpresource.org
This presentation was supported, in part, by grant number 90MP0216 from the Administration for Community Living, Department of Health and Human
Services. 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.
