Community Health Association
of Richmond & West Stockbridge
By Lauren Broussal
With permission from The Richmond Record -
On Wednesday evening, June 6, the Community Health Association of Richmond and West Stockbridge sponsored a dinner lecture on how to survive Medicare without becoming the victim of fraud or abuse. The lecture, held at the Richmond Congregational Church with a buffet dinner provided by Guido’s, was presented by Scott Simundza of the Massachusetts Senior Medicare Patrol (SMP), a federal Medicare program staffed mostly by volunteers. According to Simundza, roughly two to seven percent of total Medicare billing is lost annually to error, fraud and abuse, which amounts to up to $40 million per year. The goal of SMP is to empower seniors to help prevent these losses by taking three critical steps: protect, detect and report.
“Protect your personal information” is the first step. Simundza stated that a senior’s Medicare, Medicaid and social security numbers must all be safeguarded like credit card numbers. Medicare will never call a person to sell something, so do not give out any information to a caller. Currently Medicare is in the process of changing all account numbers, which previously had been based on clients’ social security numbers. This has led to a scam in which seniors are called or emailed by people claiming to be Medicare representatives assisting in the changeover. They request the client’s old Medicare number in order to issue a new one. He warned seniors never to respond to this scam.
Additionally, Simundza urged clients to save all Medicare Summary Notices (MSN) and Explanation of Benefits (EOB), and to shred all documents when they are no longer useful.
“Detect errors, fraud and abuse.” Most importantly, SMP urges Medicare clients to keep track of the details of all medical visits, services, tests, and treatments. MSNs, EOBs and Part D EOBs (for prescription drugs), as well as any other statements, should always be reviewed and compared to the client’s own records for any discrepancies. The senior can also visit www. MyMedicare.gov to access his/her account online. Discrepancies to watch for include charges for services that weren’t received, billing for the same thing twice, services that were not ordered, and any other questionable charges.
“Report mistakes or questions.” Any suspected errors, fraud or abuse should be reported immediately. If a client finds a discrepancy, the medical provider or insurance plan should be notified first. If that does not produce a satisfactory response, call the Mass. SMP program at 1-800-892- 0890 for help and advice. The attorney general’s office will become involved if there is evidence of fraud. The Medicare Advocacy Project (MAP) will give advice regarding legal questions related to Medicare problems, and can be reached at 1-800-323- 3205 or www.gbls.org.
For Medicare patients who are admitted to the hospital, Simundza offered an im- portant tip. It is critical to know if one is being admitted to an in-patient bed or an observation bed for insurance purposes, since there are many services that Medicare will not pay for if a patient is admitted to an observation bed. This includes transfer to a rehab facility, among others. By law, after 24 hours the hospital must inform the patient which type of bed he/she is in, and why. A group called “Livanta” that handles quality of care issues can help patients who find themselves in this quandary, and will work fast. Livanta can be reached at 1-866- 815-5440, or www.bfccqioarea1.com.
SMP also recommends that before Medicare clients undergo any type of test, treatment or procedure, they ask their providers five questions: Do I really need this? What are the risks and side effects? Are there simpler, safer options? What happens if I don’t do anything? How much does it cost and will my insurance pay for it?
Most of this information and much more can be found in the Mass. SMP “Personal Healthcare Journal,” which is an easy way to keep track of all medical visits, tests and treatments in order to compare personal records with official statements. Mass. SMP can be contacted at 1-800-892-0890, or www.medicareoutreach.org. Click on “Materials and Resources” on the home page top menu, then click on “Click here to Order Free MA SMP Materials,” fill out the form and choose “Personal Healthcare Journal.” The Medicare journal will be sent to you at no cost. ■