NEWSLETTER

JULY-SEPTEMBER 2017 Published Quarterly

Editor, Kathleen Pursell—AR SMP Director

Senior Medicare Patrol (SMP) programs empower and assist Medicare beneficiaries, their families, and caregivers to prevent, detect, and report health care fraud, errors, and abuse through outreach, counseling, and education. SMPs are grant-funded

projects of the federal U.S. Department of Health and Human Services (HHS), U.S. Administration for Community Living (ACL).

SPOOFING’S NOT A

JOKE: THOUSANDS HIT

BY PHONE SCAM

April 17, 2017 By: Judy Sarasohn, HHS (Public Affairs) The OIG hotline phone number for reporting fraud —1-800-HHS-TIPS (1-800-447-8477) was spoofed.

A Jacksonville, Florida, woman received a call last month that appeared to be from the HHS

Office of Inspector General’s (OIG) hotline. The caller told her that she had won a $9,000 grant from the federal government and all she had to do was either wire $250 to him through Western Union or give him the confirmation code for a $250 iTunes gift card. The man also wanted her to confirm her name, address and some other personal facts. She became suspicious and eventually ended the call. The Jacksonville woman may not have sent money, but she was scammed into confirming and giving out personal information that could be used to steal money from her bank account or for other fraudulent activity. She wasn’t alone. The OIG hotline phone number for reporting fraud — 1-800-HHS-TIPS (1-800-447-8477) — had been spoofed, a malicious practice of making a phone number appear on caller ID to be legitimate in order to obtain confidential information. Thousands of calls using the spoofed number were made to people across the nation, although only a handful of people have apparently sent money to the

perpetrators, said Thomas O’Donnell, Assistant Inspector General for Investigations at HHS. One criminal case is underway and two people are under investigation.

Just as a reminder:

The federal government never calls you

unsolicited.

The office was first informed of the spoofing attack in February by a member of the public, who reported receiving a call from the hotline number. OIG immediately launched an investigation. O’Donnell said Verizon Communications, which handles calls for several government agencies at a call center at Louisiana State University in Baton Rouge, noted that thousands of outgoing calls were being made from the hotline. But the OIG hotline doesn’t make outgoing calls, it only receives them, O’Donnell said.

The calls typically tell you that you will receive "government grant money" as an incentive for paying taxes on time. The caller will then ask for personal or financial information, such as a Social Security number or bank account number. You may also be asked to wire a payment to cover “processing fees.”

The HHS OIG office is actively investigating this latest scam, working with the FBI and other agencies’ Inspectors General and sharing information and best practices. O’Donnell said other HHS agencies may have also been attacked by scam artists who spoofed their phone numbers. “They can spoof any legitimate number,” he said.

O’Donnell said OIG proactively examined its data systems for a breach, and thankfully, they had not been accessed.

To prevent further nefarious uses of the OIG hotline number, O’Donnell said they have worked with Verizon on ways to prevent the spoofed number from being used for outgoing calls. People with legitimate calls about potential frauds and scams can safely call the hotline or report suspicious calls to spoof@oig.hhs.gov. They may also file a complaint with the Federal Trade Commission by calling 1-877-FTC-HELP (1-877-382-4357).

How to Protect Your Privacy HHS is aggressively fighting to protect patient privacy on other levels as well. These efforts are important to safeguard against the negative effects that may follow a breach of patient information; assure patient confidence in the health care system, including Medicare and Medicaid; and support the use of electronic health records.

CONTINUED ON PAGE 2

INSIDE THIS ISSUE:

FRAUD RECOVERIES...............Pg 3

Fraud in the News….…..……….Pg 4

Scams….…………………..…… Pg 5

DME Scams…….………………..Pg 6

“Roster Billing” Trend…………. Pg 6

Volunteer Spotlight…...……... ….….Pg 7

What’s KEPRO…………………...Pg 8

MOON…….………….……...........Pg 9

Upcoming Events………...…….....Pg 10

Phone Numbers /Websites......... Pg 11

SMP Mission/Partners....…..…….Pg 12

Unreported fraud, waste, and abuse in Medicare and Medicaid can cost taxpayers millions of dollars each year.

PROTECT, DETECT & REPORT—1-866-726-2916

Since its inception in March 2007, the

Medicare Fraud Strike Force, now

operating in nine cities across the

country, has charged nearly 3,000

defendants who have collectively billed

the Medicare program for more than

$11 billion.

In addition, the HHS Centers for

Medicare & Medicaid Services, working

in conjunction with the HHS Office of

Inspector General, are taking steps to

increase accountability and decrease the

presence of fraudulent providers.

2

SPOOFING’S NOT A JOKE— The Department’s Office for Civil Rights (OCR) enforces the privacy and security rules under the Health Insurance Portability and Accountability Act (HIPAA) for health plans and most health care providers to safeguard patient health information, mitigate harmful effects of a breach, and take remedial action to avoid future breaches.

People, including those who suspect they may be a victim of medical identity theft or other privacy violation, can take advantage of important rights under HIPAA, such as the right:

To inspect and receive a

copy of their medical records;

To have records amended or

corrected when inaccuracies are found; and

To file a complaint if they believe their privacy rights have been violated.

What Should You Do to Be Cyber Secure?

The HHS CyberCARE team also urges you to add a cyber checkup to your annual to-do list. Your online posts, comments, tags and followers create a wealth of personal information that bad actors can use to steal your identity and manipulate you into giving up even more confidential information. The Cyber Doc includes the following suggestions for your annual cyber checkup:

Check your social media privacy settings to make sure you’re sharing information only with friends.

Adjust privacy settings on

your watch computer and the health tracker on your wrist.

Check out social sites you

visit, including ones where you may have left restaurant or handyman reviews and delete any of your Personally Identifiable Information.

The OIG’s O’Donnell also cautioned people not to be fooled by a caller’s knowledge of their name and other personal information. Callers may use a variety of tactics, he said, to obtain some initial personal information, including by working for otherwise legitimate marketing centers. And he stressed that the OIG will never initiate contact with the public through the hotline to request or confirm personal information. Besides, he added, the government doesn’t “sell” grants.

“We don’t hand these [grants] out like candy,” O’Donnell said. “Nobody’s getting free money in this country.”

Protect Yourself from Telephone or Email Scams

No matter how authoritative a caller may sound, privacy specialists urge you to not give or confirm your name or provide any personal information to unknown individuals, including such details as your:

Social Security number

Date of birth

Credit card or bank

account information

Mother’s maiden name

***

Continued from Page 1

Medicare fraud occurs when healthcare services are deliberately misrepresented,

resulting in unnecessary costs to the program, improper payments to providers, or

overpayments. Examples are billing for services that were never provided or billing for

a service or product at a higher rate.

Check your Medicare Summary Notice for suspicious charges and report them.

Sign up for www.mymedicare.gov to check claims regularly.

The Arkansas SMP can help! Call 1-866-726-2916

Medicare Fraud, Waste & Abuse

This newsletter is paid for by a grant (#90MP0022101) from the Administration for Community Living. Its contents are solely

the responsibility of the Arkansas SMP and do not necessarily represent the official views of ACL.

3

Federal Roundup: Health Care Fraud Recoveries Increase

The Sentinel, a publication of the SMP Resource Center www.smpresource.org

May 2017

$5 was recovered for every dollar spent from the HCFAC program. By Kendra Kuehn, MSW Health Benefits ABCs

There were $3.3 billion in health care fraud recoveries in fiscal year (FY) 2016, up from $2.4 billion the previous year, according to the annual Health Care Fraud and Abuse Control (HCFAC) Program Report released by the departments of Health & Human Services (HHS) and Justice. Those funds were deposited in the Medicare Trust Fund or the Department of the Treasury, transferred to other federal agencies administering health care programs such as TRICARE, or paid to private persons (such as relators who filed suits on behalf of the federal government under qui tam provisions of the False Claims Act).

On average in FY 2014-2016, $5 were recovered for every dollar spent from the HCFAC program, according to this report. This was a decrease from the FY 2013-2015 return on investment (ROI) of $6.10 for every dollar spent. The number and types of cases settled or adjudicated during a year can cause the ROI to fluctuate significantly. To account for this effect and the multiyear nature of many cases, a three-year rolling average ROI is reported.

Combatting Fraud In FY 2016, Office of Inspector General (OIG) investigations resulted in 765 criminal actions against those participating in Medicare-or Medicaid-related crimes. Efforts also resulted in 690 civil actions, including civil monetary

penalties (CMPs). CMPs are imposed on providers and suppliers who submit false claims, participate in unlawful referral or kickback schemes, fail to appropriately treat and refer patients at hospital emergency rooms, or engage in other statutorily prohibited activities. OIG excluded 3,635 providers and suppliers engaging in abuse, neglect, or fraud. Exclusions included an osteopath billing Medicare for services never delivered, a nurse assistant convicted of sexual assault, and a clinic owner conspiring to pay kickbacks to beneficiaries when using their Medicare information for fraudulent billing.

At the Department of Justice, the Offices of the United States Attorneys (USAOs) opened 975 criminal health care fraud investigations and filed charges against 802 defendants in 480 cases. During the year, 658 defendants

were convicted of health care fraud-related charges. USAOs also opened 930 new civil

health care fraud investigations and had 1,422 fraud investigations pending at the end of the year.

The departments of Justice and HHS continue to provide support to nine regional Medicare Fraud Strike Force teams, which target those who only engage in health care fraud and do not provide any legitimate health services. Strike Force efforts resulted in charges filed against 230 defendants involved in a total of $2.1 billion in fraudulent

Medicare billing, 131 guilty pleas, 13 jury trials with guilty verdicts against 18 defendants, and 125 defendants sentenced during FY 2016, with an average of 53 months of incarceration. Medicare Fraud Strike Force teams are located in Los Angeles, California; Miami and Tampa, Florida; Chicago, Illinois; Southern Louisiana; Detroit, Michigan; Brooklyn, New York; Dallas, Texas; and Southern Texas.

Preventing Fraud In addition to investigating fraud, OIG makes recommendations for preventative legislative and administrative actions. Informed by agency feedback, these proposals work to close loopholes and reduce

improper payments or conduct. In FY 2016, the Congressional Budget Office (CBO) and department actuaries estimated that these recommended actions resulted in savings of $21 billion to Medicare and $1.1 billion to Medicaid. For further information see the OIG Semiannual Report to Congress.

The SMP program continues to play a crucial role in fraud prevention. OIG has documented over $124.6 million in total savings to Medicare, Medicaid, beneficiaries, and other payers attributed to the SMP projects since the SMP program’s creation in 1997. Since then SMPs have reached 6.6 million beneficiaries in group or one-on-one counseling and more than 30 million people through community outreach events.

The true value of SMPs is difficult to fully determine as the primary focus of the program is teaching beneficiaries how to protect themselves and avoid fraud in the first place. The report acknowledges that programs may not always receive full credit for their efforts. To measure the value of the program, the Administration for Community Living (ACL) awarded a three-year research grant to Tufts University in FY 2013. Tufts’ research will measure beneficiaries’ fraud knowledge, attitudes, and behaviors before and after attending SMP sessions. Preliminary results show that it is possible to show the value of SMP efforts. Final research results are expected in FY 2017. Budgetary Outlook Meanwhile, the new administration and Congress are developing budget proposals for fiscal year 2018. President Donald Trump’s discretionary budget blueprint was released in March 2017. This proposal would increase discretionary spending for HCFAC to $751 million, a $71 million increase over the FY 2017 annualized continuing resolution level. The president’s full budget proposal is expected this month [May 2017] and was not available for analysis at press time.

***

Exclusions included an osteopath billing Medicare

for services never delivered; a nurse assistant

convicted of sexual assault; and a clinic owner conspiring to pay kickbacks to beneficiaries when using their Medicare information

for fraudulent billing.

Tips for family members of Alzheimer’s patients

Family members should fit themselves into the Alzheimer's patient's world, instead of expecting the patient to fit into the family member's world. Here are some tips to help:

Keep it simple: give two choices: pink or blue; Family members should use name tags when visiting such as: YOUR DAUGHTER LINDA; "Holy Fibs" are okay - go along to avoid conflict; Redirect their attention -If patient wants to go home, ask them, “what would you do first on arriving home?” During meals, assist from in front of patient, not from side, and call out food names while assisting. Don’t correct-who cares if patient gets details wrong! There are more important things than "being right". Part on a pleasant note.

FRAUD IN THE NEWS —

Nursing Home Operator Agrees to Pay Prestige Healthcare has agreed to pay almost $1 million to resolve allegations that it violated the False Claims Act regarding its role in an

alleged scheme to falsely bill Medicare for unnecessary genetic testing. The United States alleged that Prestige failed to ensure that physician

orders were obtained for the genetic testing prior to its being conducted and that Prestige physicians were not aware of and did not agree with

the testing’s medical necessity. It also alleged that Prestige failed to ensure that its patients were appropriately informed of the testing prior to

its being conducted and given the opportunity to decline.

To read a Department of Justice press release, go to: https://www.justice.gov/usao-wdwi/pr/prestige-healthcare-agrees-pay-nearly-1-million-role-alleged-false-billing-genetic

Detroit-Area Physician Pleads Guilty In a $17.1 million Medicare fraud scheme, a physician admitted he saw patients who did not qualify for his services and whose visits were

billed to Medicare at the highest billing codes. He also admitted that he prescribed to patients medically unnecessary narcotics, such as

Vicodin, in exchange for the ability to bill Medicare for the patients' visits. To read a Department of Justice press release, go to:

https://www.justice.gov/opa/pr/second-detroit-area-physician-pleads-guilty-171-million-health-care-fraud-scheme

The Arkansas Senior Medicare Patrol (SMP) is federally funded by a grant from the Administration on Aging (AoA) Administration for Community Living (ACL) and administered by the Arkansas Department of Human Services, Division of Aging & Adult Services

4

State Health Insurance

Information Program (SHIIP)

Contact Arkansas SHIIP

800-224-6330 for personalized,

one-on-one counseling and assistance with

understanding Medicare!

SCAM TIP!

The federal government

never calls you

unsolicited.

U nscrupulous doctors, pharmacists and medical suppliers sometimes form an alliance and

overprescribe medications, ointments and supplies to patients. The providers then bill Medicare and divide the profits among themselves. Medications and other supplies are oftentimes substituted with generic or less expensive products, unbeknownst to the patient.

Always a Step Ahead

Scamsters are always a step ahead! The best way to protect yourself from being victimized is to be aware of the most recent types of fraud/scams emerging locally and around the country. Sign up to receive the quarterly Arkansas SMP Newsletter – Call 866-726-2916.

Tips:

Be wary of offers for FREE medicine or medical

equipment – these are probably scams.

Do not give out your Medicare number to a stranger,

especially over the phone.

Your Primary Care Physician (PCP) should write your

prescription(s). Never allow a doctor you've never met to prescribe any medications, medical equipment or home health care services.

Review your monthly Medicare statement to see if it

contains billing charges that seem suspicious or in error.

Report suspicious or fraudulent activity to the

Arkansas SMP – 866-726-2916.

If you want to take an active role, join the Senior Medicare Patrol (SMP), a nationwide network of volunteers who educate the public about Medicare fraud. Contact the Arkansas SMP for more information or to volunteer by calling 866-726-2916.

Be aware of the following SCAM(s):

Report all scams to the Arkansas SMP — 1-866-726-2916

CHANGES ARE COMING TO YOUR MEDICARE CARD—

Have you heard you will be receiving a new Medicare card? Are you wondering when? This won’t

happen until April 2018 but scammers are already ahead of the game and using this as an opportunity for fraud.

This change to remove social security numbers from Medicare cards is to help prevent fraud and protect your identity.

Currently, for most people, their Social Security number is their Medicare number. This makes collecting Medicare

numbers an easy target for scammers to steal your identity, open new credit cards or take out loans in your name. The

new number, however, will not be tied to your Social Security number and is therefore more secure.

Scammers are able to use this to their advantage by calling Medicare beneficiaries claiming to be with Medicare and

stating that they must confirm their current Medicare numbers before sending the new card. Others call saying there

is a charge for the new card and are collecting beneficiaries’ personal information. The new card will be mailed to

you automatically; and there is not charge. It is FREE!

PLEASE BE AWARE THAT there is no charge for your new card and Medicare will never call you for your

information. They already have it. Government agencies like Medicare, the IRS and Social Security WILL NOT

CALL YOU!

If you receive calls about this change or other suspicious solicitations, hang up and call the Arkansas Senior Medicare

Patrol (SMP) at 1-866-726-2916.

US DHHS HOTLINE — The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG)

recently confirmed that the OIG Hotline telephone number, 1-800-HHS-TIPS (1-800-447-8477), is being used as

part of a telephone spoofing scam! Scammers represent themselves as HHS OIG Hotline employees and can alter

the appearance of the caller ID to make it seem as if the call is actually coming from the HHS OIG Hotline . The

perpetrator may use various tactics to obtain or verify personal information, which can then be used to steal money

from an individual’s bank account or for other fraudulent activity.

The Hotline telephone number will not be used to make outgoing calls and individuals should not answer calls

from 1-800-HHS-TIPS (1-800-447-8477).

Protect your personal information—guard against providing personal information during calls that purport to be

from the HHS OIG Hotline.

It is still safe to call into the HHS OIG Hotline to report fraud.

Let calls from

unfamiliar numbers

go to voicemail.

Legitimate callers

will most likely

leave a message -scammers won’t!

By Nat Wood

June 20, 2017

THE FTC DOESN’T NEED YOUR BANK INFO — Some people have gotten an email that claims to be from

Maureen Ohlhausen, the FTC’s Acting Chairman. But it’s not. The email asks you to give your bank account

information – so, it says, you can get money from the government’s settlement with Western Union. The email is a

scam to steal your financial information. And it’s just the latest variation of an imposter scam.

If you get an email like this, don’t respond or click on any links. You can forward it to the FTC at spam@uce.gov.

The FTC is involved in a $586 million settlement with Western Union, but the U.S. Department of Justice will run the

refunds process. And it hasn’t started yet.

The FTC will never ask for money, your Social Security number, or any banking information so you can apply for a

refund or cash a check. If the FTC needs to get money to you, they usually send a check through the mail.

HANG UP ON

PHONE FRAUD!

5

Walkers and Wheelchairs and

Braces, Oh My!

By Jenna Gladfelter

SMP-NY Program Director

H ave you ever received a postcard in

the mail saying you’re eligible for a

free back brace? Maybe someone has called

to tell you that your doctor has approved you

for a free knee brace – all you need to do is

provide your Medicare number! Sounds like

a good deal, right? Maybe too good?

Unfortunately, it is. Durable medical

equipment (aka DME) scams are some of

the most common forms of health care

fraud. But what exactly is DME? And why

are these offers considered scams?

First, DME is designed to mainly be used in

your home. It could be a walker, a

wheelchair, a hospital bed, or some kind of

brace. These pieces of equipment are

intended to uniquely fit you! For example, a

knee or back brace will require your

measurements. A wheelchair will not only fit

your body but also be specially measured

to ensure you can move throughout your

home. A DME supplier is required to

thoroughly gather this information and to

ensure a perfect fit.

Secondly, there are several reasons these

phone calls and postcards could be

considered scams. To start, Medicare

representatives are not allowed to solicit by

phone. And in order for Medicare to cover a

piece of DME in the first place, you need a

prescription from a doctor stating why you

need it. Lastly, DME is covered by your Part

B plan and almost always has a copayment.

So what’s in it for the scammer? Two things: personal information and money!

With these scams, the person on the phone

will almost always ask for your Medicare

number, which also happens to be your

Social Security number. That information

in the wrong hands could be really

harmful. Most of the time, scam artists

will then bill Medicare for a piece of

equipment – sometimes more expensive

than the one they may have sent you –

and collect the money for themselves.

Not only can they wrongfully use your

Medicare benefits but they also could,

and often do, commit identity theft. With

your Social Security number, they are

able to open bank accounts and credit

cards and request loans in your name –

all without your knowledge or

permission.

This sounds bad. How can I protect myself?

We’re glad you asked…

We like to tell people that knowledge is

power. By knowing how scammers operate,

you can stop them in their tracks. It’s

important to be wary of any offers that

promise “free” products or services. After

all, there’s no such thing as a free lunch!

So, don’t be afraid to hang up the phone or

toss that postcard in the trash.

However, you don’t just have to play defense.

YOU can help us fight fraud! We encourage

you to be proactive and report any

suspicious activity to the Arkansas Senior

Medicare Patrol. This information not only

shows us if scammers are targeting a

specific neighborhood, zip code, or city, but

it also helps us report fraud trends to the

proper authorities.

If you ever have any questions or concerns,

don’t hesitate to contact the Arkansas

Senior Medicare Patrol. We’re here to help

you.

ARKANSAS SENIOR MEDICARE PATROL —866-726-2916 —

COMBATTING

OVER-UTILIZATION IN

LONG TERM CARE AND

ASSISTED LIVING

FACILITIES

Over the past few years an emerging trend

has been seen with physicians and nurse

practitioners providing non-medically

necessary services to residents in nursing

homes and assisted living facilities. This

trend is often referred to as “Captive

Audience” or “Roster Billing”.

WHAT IS CAPTIVE AUDIENCE AND

ROSTER BILLING?

Captive Audience refers to locations

where multiple Medicare beneficiaries are

housed. This includes nursing facilities,

assisted living facilities, and senior living

communities. Roster Billing is often done

from places where there is a “Captive

Audience”. In a Roster Billing scenario a

physician or nurse practitioner will obtain

a list (roster) from the facility they are

visiting with all the active residents, they

will then bill a Subsequent Nursing

Facility Care visit (CPT codes 99307-

99310) for each resident regardless of

need or if they were actually seen. In these

scenarios we often see patients getting

billed for visits every two to four weeks,

or in the most aberrant cases weekly.

WHAT MEDICARE SAYS

Codes 99307-99310 (Subsequent Nursing

Facility Care, per day) shall be used to

report federally mandated physician visits

and other medically necessary visits.

Medicare will pay for federally mandated

visits that monitor and evaluate residents

at least once every 30 days for the first 90

days after admission and at least once

every 60 days thereafter.

While the Medicare policy states that

these codes should only be used one every

60 days after the first 90 days of

admission, they can be used more

frequently if the patient has an

exacerbation of their condition requiring a

physician visit.

HOW TO IDENTIFY ROSTER

BILLING

The most important step in identifying

Roster Billing is reading the Medicare

Summary Notices.

If there is a constant charge for a nursing

facility visit or multiple visits every

month, this could be the first clue that a

physician is Roster Billing. Another clue

would be if a beneficiary states that the

same physician or nurse practitioner

comes around to see them every two

weeks, but no real medical exam takes

place. Often times these visits will just

include talking with the beneficiary or

taking their vitals. Lastly, be mindful of

specialists that appear without a request

such as podiatrist or psychiatrist.

REMEMBER….beneficiaries always

have a choice on what physician they do

or do not want to see.

Submitted by: Julie Doriety,

Program Integrity Supervisor

for AdvanceMed

6

This newsletter was supported in part by a grant (No. 90MP0022101) from the Administration for Community Living (ACL). Grantees carrying out projects under

government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not necessarily represent official ACL or DHHS policy.

Really Special and Valuable People!Really Special and Valuable People!Really Special and Valuable People! SMP VOLUNTEERS IN THE SPOTLIGHT!

The Arkansas SMP is currently recruiting volunteers! COME JOIN THE FUN!

For more information, please contact Dee Edwards,

Arkansas SMP Volunteer Coordinator

—1-866-726-2916— SMP - Empowering Seniors to Prevent

Medicare Fraud 7

Kathleen Pursell, Dee Edwards and

Jeanett Stuart. our new SMP Volunteer

from Fountain Place in Cherokee

Village. Welcome aboard Jeannett!

Susan Mullins, Activities Director and Tricia

Jones, Director of the Fountain Place Christian

Retirement Community, Cherokee Village.

Susan signed up to volunteer for SMP!

We are happy to have you Susan!

Dee Edwards and SMP Volunteer

Ricarda Snellback! Welcome back

Ricarda!

Dee Edwards and SMP Volunteer

Saundra Calhoun from Wesley on the

Ridge in Jonesboro.

Saundra Calhoun conducting her FIRST SMP Fraud Bingo!

Dee Edwards with new SMP

Volunteer Betty Williams from

Golden Age Apartments in Pine

Bluff! Welcome Betty!

NEW SMP Volunteer

Judy McGuire from Red

Oaks Landmark Missionary

Baptist Church—Hot

Springs.

8

Are you a QMB and have been

wrongfully billed for Medicare costs?

If you are enrolled in the Qualified Medicare Beneficiary

(QMB) Program, you should not be billed for Medicare-

covered medical services, equipment, or supplies. Your

Medicare premiums, deductibles, coinsurance, and

copayments are all covered by Medicaid.

There are reports from the Centers for Medicare &

Medicaid Services (CMS) of people being wrongfully

billed even though they have QMB coverage. Also, the

Consumer Financial Protection Bureau (CFPB) receives

reports that debt collectors repeatedly attempted to collect

these types of bills.

If you are wrongfully billed or receive calls from debt

collectors on bills that were wrongfully sent, you can:

Contact the provider or debt collector and tell them you

are enrolled in the QMB Program and cannot be

charged for Medicare deductibles, coinsurance, and

copayments. You have the right to a refund for any

payments you’ve already made.

Call 1-800-MEDICARE (1-800-633-4227) if the

medical provider won’t stop billing you or refuses to

issue a refund, and they can ask the provider to stop

improper billing and to refund any incorrect payments

you made.

Submit a complaint online or call the CFPB

at 1-855-411-2372.

https://www.consumerfinance.gov/about-us/blog/what-do-if-

youre-wrongfully-billed-medicare-costs/

DID YOU KNOW?

You can electronically receive your Medicare Summary

Notices (eMSN’s)!

Visit mymedicare.gov to find out how to get eMSNs.

If you choose to do so, you’ll get a monthly email

(eMSN) instead of having to wait for the paper copy to

be mailed every 3 months.

Go to www.mymedicare.gov and click on “Create an

account.”

What is KEPRO? KEPRO, Arkansas’ Quality Improvement Organization, provides three services for beneficiaries:

1. Discharge appeals 2. Beneficiary complaints 3. Immediate Advocacy

KEPRO’s services are free for Medicare beneficiaries and their representatives

For more information: www.keproqio.com; 216-339-4775; Lisa.Stansbury@bfcc2.hcqis.org

Beneficiaries calling for Immediate Advocacy should choose option 1 on the first prompt followed by option 2 to be connected to the beneficiary complaint department.

DO YOU EXERCISE?

Many seniors live on a fixed income

that does not leave them with enough

discretionary income to purchase a

health club membership or even buy exercise DVDs.

Reap the benefits of fitness by walking (outdoors or in

a public space like a shopping mall); check out video

streaming exercise routines via YouTube; check out

exercise DVDs from the library; or click on this link to

follow these FREE printable exercise worksheets

Resource:

www.caregiverstress.com/geriatric-professional-resources/professional-

development/5-social-determinants-that-can-impact-senior-exercise/

DON’T ACCEPT ITEMS

received through the mail

that you didn’t order. Refuse the delivery!

Don’t open it, and return it to the sender.

Keep a record of the sender’s name and the date

you returned the item(s).

DME

FRAUD! A GREAT RESOURCE

for answers to many

questions you may have

about your Medicare…

Medicare Interactive:

https://www.medicareinteractive.org/

9

Don’t let

others

become

victims!

Pass it on…

Help make

others aware of

fraud and

how to avoid

scams and

financial

abuse.

faceboo

k.co

m/arsm

p

What you should know

about Medicare-covered

orthotics…

Some diabetic equipment

suppliers are reacting to

lower Medicare

reimbursements for testing

strips by aggressively

marketing other equipment,

such as back braces, that are

not subject to competitive

bidding rules.

Beneficiaries and their

caregivers need to know that

Medicare covers back braces,

knee braces, cervical collars,

and other braces as orthotics,

when they are “furnished

incident to physicians’ services

or on a physician’s order,” and

“used for the purpose of

supporting a weak or deformed

body member or restricting or

eliminating motion in a

diseased or injured part of the

body.”

“For an item to be covered by

Medicare, a detailed written

order (DWO) must be received

by the supplier before a claim

is submitted.

If the supplier bills for an item

… without first receiving the

completed DWO, the item will

be denied as not reasonable

and necessary.”

Special documentation rules,

including justification for the

specific item in the ordering

physician’s records, apply to off

-the-shelf orthotics.

Medicare doesn’t cover back

braces without full

documentation of medical

necessity and that suppliers

that receive Medicare

payments for unneeded,

unwanted, or substandard

equipment run the risk of

prosecution for False Claim Act

violations.

Some DME suppliers that

furnish mail-order diabetic

supplies are using

telemarketers to make

repeated calls to existing

customers with offers of free or

low-cost back braces. Some

beneficiaries give in to the

pressure or persuasion and

authorize the suppliers to

contact their physicians with

faxed orders.

Call 1-866-726-2916 to receive the SMP Newsletter.

LOOKING GOOD

My face in the mirror isn't wrinkled or drawn.

My house isn't dirty. The cobwebs are gone.

My garden looks lovely and so does my lawn.

I think I might never put my glasses back on.

Medicare

Outpatient

Observation

Notice (MOON)

(Effective March 8, 2017 hospitals must begin providing the MOON to patients in observation status for more than 36 hours.)

The MOON is a

standardized notice to

inform beneficiaries

(including Medicare

health plan enrollees)

that they are an

outpatient receiving

observation services and

are not an inpatient of

the hospital or critical

access hospital (CAH).

The MOON is mandated

by the Federal Notice of

Observation Treatment

and Implication for Care

Eligibility Act

(NOTICE Act), passed

on August 6, 2015.

The NOTICE Act

requires all hospitals and

CAHs to provide written

and oral notification

under specified

guidelines.

For your free copy of the SMP brochure entitled:

“DIABETES SCAMS — What Should you Do?”

Call —1-866-726-2916

Sign up to receive

Scam Alerts by calling 866-726-2916.

CMS will issue new Medicare cards with a new unique, randomly-assigned number called a Medicare Beneficiary Identifier (MBI) to replace

the existing Social Security-based Claim Number. CMS will start mailing new cards to people with Medicare benefits in April 2018. All Medicare cards will be replaced by April 2019.

LAUGH! Not only does laughter make you feel good, its positive effects stay with you long

after the chuckling subsides. Research shows that laughter lowers stress hormones, relaxes

muscles, improves mood, and eases anxiety. According to HelpGuide.org, “Humor helps you keep a

positive, optimistic outlook through difficult situations, disappointments, and loss.”

REMINDER!

Scammers are skilled liars.

They’ll say anything or

claim to be anyone to get

your personal and financial

information – then they’ll

use it to steal money from

your accounts or commit

other crimes.

SMP is a nationwide federal grant

program funded in part by the U.S.

Administration for Community Living.

The Arkansas SMP grant is

administered by the

Arkansas Department of

Human Services

Division of Aging & Adult Services.

Upcoming Arkansas SMP Activities DATE ACTIVITY COUNTY

July 10-13 SMP/SHIIP National Training Meeting—Austin TX Texas

July 17 SMP Fraud Bingo—Christopher Homes—West Helena Phillips

July 18 SMP Fraud Bingo — Wesley on the Ridge—Jonesboro Craighead

July 25 Volunteer Training—SEARSVP Jefferson

July 26 St. Anthony’s Volunteer Recruitment—Morrilton Conway

July 28 SMP Exhibit Booth — Hope for the Future — Conway Faulkner

August 3-5 SMP Exhibit Booth — AEMTA Conference — Hot Springs Garland

August 18 SMP Exhibit Booth — Hope for the Future — Newport Jackson

August 22 Volunteer Training—MDCC Phillips

August 29 SMP Fraud Bingo—Senior Center—Morrilton Conway

September 8 SMP Presentation—Hope for the Future—Helena Phillips

September 12 Arkansas SMP Quarterly Advisory Council Meeting—Little Rock Pulaski

September 14 SMP Exhibit Booth— Hope for the Future— Harrison Boone

September 14 SMP Exhibit Booth — Village House—Rioradan Hall—Bella Vista Benton

September 26 SMP Exhibit Booth — ARTA Convention — Benton Saline

September 26 SMP Exhibit Booth — Senior Circle — Siloam Springs Benton

September 27 SMP Presentation—Watson Chapel Baptist Church—Pine Bluff Jefferson

October 4 SMP Exhibit — AHAA Annual Conference — Embassy Suites — Little Rock Pulaski

October 17 S.A.L.T. — Rogers Benton

October 20 SMP Presentation—Hope for the Future — Magnolia Columbia

October 21 SMP Exhibit — Arkansas Democrat-Gazette SENIOR EXPO—Little Rock Pulaski

October 27 SMP Presentation— 8th Street Missionary Baptist Church—NLR Pulaski

December 5 SMP Volunteer Appreciation Pulaski

December 7 SMP Presentation — Lunch & Learn—Faith UMC — Little Rock Pulaski

We would welcome any opportunity to present the SMP message statewide.

Please contact the Arkansas SMP to schedule a presentation in your area—1-866-726-2916.

10

IMPORTANT PHONE NUMBERS:

AANHR—AR Advocates for Nursing Home Residents 501-450-9619

AFMC—AR Foundation for Medical Care 1-888-354-9100

Area Agency on Aging 1-800-986-3505

AG-Attorney General (Consmr Prot Div) 1-800-482-8982

AG Medicaid Fraud Hotline 1-866-810-0016

APS—Adult Protective Services (DHS) 1-800-482-8049

Arkansas Rehabilitation Services 1-800-981-4463

AR SMP (Healthcare Fraud Complaints) 1-866-726-2916

Better Business Bureau (BBB) 501-664-7274

CMS—(Medicare)— (Centers for Medicare and Medicaid Services)

(1-800MEDICARE) 1-800-633-4227

Community Health Centers of AR 1-877-666-2422

Coordination of Benefits 1-855-798-2627

DHS (Customer Assistance Unit) 1-800-482-8988

Do Not Call Registry 1-888-382-1222

Elder Care Locator 1-800-677-1116

El Dorado RSVP 1-870-864-7080

Federal Trade Commission

Report STOLEN IDENTITY 1-800-438-4338

ICan—Increasing Capabilities Access Network 501-666-8868

KEPRO -AR QIO(Quality Improvmnt Org.) 1-844-430-9504

Medicaid—(Claims Unit) 1-800-482-5431

Medicaid Inspector General (OMIG) 1-855-527-6644

MEDICARE (CMS 1-800-MEDICARE) 1-800-633-4227

Medicare Part D 1-877-772-3379

Medicare Rights Center 1-800-333-4114

Mid-Delta Community Consortium 1-870-407-9000

NCTRC (Nat’l Consumer Tech Resrc Cntr 1-877-808-2468

Oaklawn Foundation/Center on Aging 501-623-0020

OIG-Nat’l Medicare Fraud Hotline 1-800-HHS-TIPS

(OIG) Office of Inspector General 1-800-447-8477

OLTC—Office of Long Term Care 1-800-LTC-4887

OLTC—Abuse Complaint Section 501-682-8430

Ombudsman—State Ofc of Long Term Care 501-682-8952

Resource Center (ADRC) 1-866-801-3435

(DHS’S Choices in Living Resource Center)

RSVP of Central Arkansas 501-897-0793

Senior Circle (Northwest Health System) 1-800-211-4148

SHIIP (Senior Health Ins.Info Program) 1-800-224-6330

SMP Locator—(locate an SMP outside AR) 1-877-808-2468

SSA (Social Security Administration) 1-800-772-1213

Little Rock Office 1-866-593-0933

SSA Fraud Hotline 1-800-269-0271

South Central Center on Aging 1-866-895-2795

Texarkana Regional Center on Aging 1-870-773-2030

Tri-County Rural Health Network 1-870-338-8900

UALR Senior Justice Center 501-683-7153

UofA Cooperative Extension Service 501-671-2000

HELPFUL WEBSITES:

ADRC—AR Aging & Disability Resource Center (DHS)—

www.choicesinliving.ar.gov/

AR Advocates for Nursing Home Residents—

www.aanhr.org; e-mail: Info@aanhr.org

AR Long Term Care Ombudsman Program—

www.arombudsman.com

Arkansas 2-1-1—www.arkansas211.org

(Get Connected. Get Answers) —1-866-489-6983

Arkansas Aging Initiative—http://aging.uams.edu/?

id=4605&sid=6

Arkansas Attorney General—www.arkansasag.gov

Arkansas Attorney General Consumer Protection

Division—e-mail: consumer@ag.state.ar.us

Area Agencies on Aging—www.daas.ar.gov/aaamap.html

Arkansas Foundation for Medical Care—www.afmc.org

Arkansas SMP—www.daas.ar.gov/asmp.html

BBB (Better Business Bureau)— scams and alerts— https://www.bbb.org/scamtracker/arkansas/

CMS (Medicare) Centers for Medicare and Medicaid Services—

www.cms.hhs.gov

Do Not Mail—www.DMAchoice.org

Elder Care Locator—www.eldercare.gov

H.E.A.T—www.stopmedicarefraud.gov/

(Healthcare Fraud Prevention and Enforcement Action Team)

ICan AT4ALL—Tools for Life—www.ar-ican.org

MEDICAID—www.Medicaid.gov

MEDICAID INSPECTOR GENERAL (OMIG)—

http://omig.arkansas.gov/fraud-form

MEDICARE—www.medicare.gov

Medicare Interactive Counselor—

www.medicareinteractive.org

Hospital Compare—www.hospitalcompare.hhs.gov

MyMedicare.gov—www.mymedicare.gov

(Access to your personal Medicare claims information)

MyMedicareMatters.org (National Council on Aging)

Office of Long Term Care—http://

humanservices.arkansas.gov/dms/Pages/oltcHome.aspx

Office of Inspector General (OIG)—email:

HHSTips@oig.hhs.gov

Pharmaceutical Assistance Program—

medicare.gov/pap/index.asp

Physician Compare—www.medicare.gov/find-a-doctor

SMP Locator—SMPResource.org (locate an SMP outside of AR)

Social Security Administration (SSA)—www.ssa.gov

SSA OIG—Report SS Fraud—https://oig.ssa.gov/report

TAP—www.arsinfo.org (Telecommunications Access Program)

UofA Cooperative Extension Service—

www.uaex.edu (or) www.arfamilies.org

Working Disabled—www.workingdisabled-ar.org 11

SENIOR MEDICARE PATROL (SMP) MISSION

“To empower and assist Medicare beneficiaries, their

families, and caregivers to prevent, detect, and report

health care fraud, error, and abuse through outreach,

counseling, and education.”

TO PREVENT HEALTHCARE FRAUD—

Protect Personal Information

* Treat Medicare/Medicaid and Social Security numbers like credit card numbers.

* Remember, Medicare will not call or make personal visits to sell anything!

* READ and SAVE Medicare Summary Notices (MSN) and Part D Explanation

of benefits (EOB), but shred before discarding.

Detect Errors, Fraud, and Abuse

* Always review MSN and EOB for mistakes.

* Compare them with your Personal Health Care Journal.

* Visit www.mymedicare.gov to access your personal account online to look

for charges for something you did not get, billing for the same thing more than

once, and services that were not ordered and/or you never received.

Report Mistakes or Questions

* If you suspect errors, fraud, or abuse, report it immediately! Call your provider

or plan first.

* If you are not satisfied with their response, call the Arkansas SMP.

TO RECRUIT & TRAIN VOLUNTEERS—

* Retired seniors;

* Retired health-care providers; or

* Retired professionals, e.g., teachers, accountants, attorneys, investigators, nurses.

Arkansas Senior Medicare Patrol (SMP)

P. O. Box 1437 Slot S530

Little Rock, AR 72203-1437

http://www.daas.ar.gov/asmp.html

FACEBOOK.COM/ARSMP

AR SMP PARTNERS

El Dorado Connections RSVP El Dorado, AR 870-864-7080

RSVP of Central Arkansas Little Rock, AR 501-897-0793

Oaklawn Foundation Hot Springs, AR

Mid Delta Community Consortium West Helena, AR

870-407-9000

Tri County Rural Health Network Helena, AR

870-338-8900

Texarkana Regional Center on Aging

Texarkana, AR 870-773-2030

South Central Center on Aging Pine Bluff, AR 870-879-1440

South East Arkansas RSVP Pine Bluff and Stuttgart, AR

870-673-8584

Senior Health Insurance Information Program (SHIIP)

Little Rock, AR 800-224-6330

To receive the Arkansas SMP Newsletter electronically

email: kathleen.pursell@dhs.arkansas.gov

Current and archived newsletters available at:

www.daas.ar.gov/asmpnl.html

To Report Medicare Fraud, Waste & Abuse

Call the Toll-Free Helpline 8:00am—4:30pm

1-866-726-2916