Funded by the U.S. Department of Health & Human Services - Administration on Community Living / Administration on Aging

Transcription

1 Funded by the U.S. Department of Health & Human Services - Administration on Community Living / Administration on Aging

2 Cases Media & PR SMP Business SMP April 2017 Conference Schedule for webinars Open Mic 2

3 7 23 cases in total, 10 from SMP Liaisons/Partners 3/23 Linda Chavez, SMP Liaison and RSVP Director 2/23 Ellise Hanson, SMP Liaison-Butte, Colusa, Glenn, Plumas, Tehama, PSA 3 1/23 Claire Pisching, SMP Liaison- Fresno 1/23 Genesis Sanchez, SMP Liaison- Merced 1/23 Pamela King, Program Manager- Santa Cruz 1/23 Alma Quezada, HICAP Counselor- Orange County 1/23 Fernanda Garcia, HICAP Counselor-Riverside Closed-Action taken by referent 1 Referred to the CA Board of Pharmacy 9 Referred to the ACL, OIG contact, and Centers for Program Integrity 4 Referred to the Dept. of Managed Health Care 3

4 CASES OUTREACH 4

5 Linda Chavez, RSVP Director and SMP Liaison Hearing Without Limits Reached out to a service coordinator of a senior residential facility Offered free hearing tests for the residents Offered lunches for the residents Work with Medi-Cal t get them hearing aids at no cost to them Tests provided by local providers/hearing specialist Hold two clinic days per year, which include offering the residents free batteries and cleaning their hearing aids, free of cost. The organization is based in the bay area, and offer services to LA and OC areas. Nina, the director, believes she has worked with some of the RSCs at their sites. Her name is Nina and website is th Street, Oakland, CA 94612, phone number SMP submitted this to Bureau of Medi-Cal Fraud & Elder Abuse (BMFEA), ACL and CMS Program Integrity 5

6 Ellise Hanson, SMP Liaison-Butte, Colusa, Glenn, Plumas, Tehama, PSA 3 American Senior Benefits Beneficiary was contacted by phone from a representative with American Senior Benefits. He wanted to set up an appointment to come to her house to go over her medical insurance needs. Client said two individuals came to her door wanting to know if she had Medicare, what supplement she had, and if she would like to change it. Continue to have a problem with illegal and aggressive marketing of Medicare Supplements in Chico. SMP referred case to the Dept. of Managed Health Care and reported via online at the CA Dept. of Insurance website 6

7 New Medicare Card Phone Scam Beneficiary received a cold call from Sarah Fisher with Medicare Caller stated that Medicare is making changes and will be sending her a new Medicare card Beneficiary provided her personal information upon request along with her husband s information so that he can get his new card, too Caller also stated that Medicare is now covering prescription drug costs and copayments, entitled to $130 each Caller proceeded to ask for the beneficiary's bank account information, in which beneficiary refused to provide this This case was referred to the ACL and Chris Schrank with OIG. 7

8 New Medicare Cards Coming in 2018 ~ Beware of Scams MARCH 10, 2017 Due to Congress passage of the Medicare Access and CHIP Reauthorization Act (MACRA) in 2015, the Centers for Medicare and Medicaid Services is required to remove Social Security numbers from all Medicare cards. CMS will start mailing out new cards in April 2018 with a new 11-digit Medicare number not linked to your Social Security. This change is to help prevent fraud and protect your identity. But scammers are using this situation as an opportunity for fraud. Learn of the common scams and where to report such scams. Please share. Available in English, Spanish, Chinese, Vietnamese, Korean, Russian, Farsi and Tagalog. 8

9 Beware of Postcards Advertising Free Braces to Relieve Pain OCTOBER 13, 2016 Be alert to urgently marked postcards notifying beneficiaries of pending eligibility for free Medicare-covered back and/or knee braces. This is a scam. Medicare only covers such equipment if it is medically necessary and prescribed by a doctor. These scammers just want to get your Medicare number to bill for services/equipment you never receive, or equipment much more expensive than what you receive. 9

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11 Steps: Handling Complex Cases Follow these 4 easy steps: STEP 1: Who? What? When? Where? Why? How? Most likely, the beneficiary will not have all of the answers to our questions, so follow-up calls are necessary. The collection of detailed information and documentation is crucial for laying out the foundation for the work ahead of us. Review SMP Fraud Worksheet or Marketing Fraud Worksheet STEP 2: Review the issue and all documentation related to it. STEP 3: Contact the provider (if it s okay with the beneficiary) and Medicare to get more information about date of service in question. If you receive cooperation from the provider, see if you can solve without having to make a referral. STEP 4: If you feel this issue is potential Medicare fraud, waste, or abuse, refer this issue to your Senior Medicare Patrol office in Orange County. You can mail or fax report with all its supporting documents. FYI: To reach Sandy Morales, please reach me via: SMP Fraud Hotline: smorales@cahealthadvocates.org *Home office: No voic set-up

12 -Designated by HICAP program manager/or host organization to be the liaison/volunteer -Agrees to formal memorandum of understanding/or volunteer agreement -Point of contact for allegations of fraud and presentation requests -Is the bridge between HICAP and SMP -Works closely with the HICAP outreach and volunteer coordinator to: -Educate the County s HICAP volunteer counselors about Medicare fraud at in-service meetings -Remind counselors to discuss fraud with clients and check the fraud box on intakes -Participate in outreach events to include SMP message -Disseminates SMP materials - Participate on Contractors State License Board scam panels - Attend 2 nd Thursday of the month Linked Up webinars - Attend 4 th Thursday of the month educational webinars - Attend semi-annual liaison training conferences -Report time spent on SMP activities via the SMP monthly timesheet (due the 15 th of the following month)

13 Publications & Media Update April Medicare Minute How Medicare Works with Current Employee Insurance Access MMs on the SMP Resource website Recent Articles, Blogs & Alerts May is Older Americans Month ~ Aging Out Loud Trump s Budget Targets Medicare Counseling Program For Cuts Need an Insurance Agent Who Speaks Your Language? New Online Tool Can Help President s Proposed Budget Would Eliminate SHIP Funding How to Take a Better Break ~ A Non-Medicare Tip on Self Care We Won a Victory for Health Care Last Week & Our Vigilance Must Continue Over 8,800 Californians Affected By Largest Long-Term Care Insurance Company Insolvency New Medicare Cards Coming in 2018 ~ Beware of Scams CHA advocates for 2 family caregiver support bills: AB 806 & SB

14 Publications & Media Update Fun ways to engage in May s Older Americans Month ~ Aging Out Loud! You all are amazing! And I d like to highlight you and how you age out loud. Basically ways you live, give, celebrate, express, share You with the world. Share a paragraph and a pic and send it to me at kfletcher@cahealthadvocates.org Send me a selfie with a with a sign stating: I age out loud by or Age out loud because Include the hashtags #OAM17 and #AgeOutLoud. Happy Spring to you all! I look forward to seeing you! 14

15 I received March timesheets/reports or heard nothing to report from: Sandy Howell Barbara Long Marian Last Ray Jones Evelyn Taylor Adrienne Omansky Gary Molina Richard Woodward Claire Pisching Scott Whiteman Cristina Garcia Genesis Sanchez Sarah Barnard Renato de Moraes Karen Fletcher Linda Chavez Abe Wischnia Ellise Hanson Judi McCarter MayLee Berry If you submitted your timesheet and your name is not listed please let me know. It s not too late to send them in!

16 Jasmine Suo Monthly SMP Liaison Timesheets SMP Partner Outreach Hours Sandy Morales- Complex Cases SMP Outreach Volunteer Micki Nozaki

17 May 25, 2017 (4 th Thursday Educational Webinar) Title: More Than Just A Band-Aid Speaker: Connie Alarcon, Better Business Bureau Time: 10:00 a.m. 11:30 a.m. Upcoming SMP Partner Call: April 20 th at 9:30 a.m.

18 SMP Spring Conference April 25, 2017 Wyndham Hotel in Irvine, CA Sarah Barnard Pat Macholl Abe Wishnia Gene Campbell Renato de Moreas Richard Woodward Linda Chavez* Sandy Morales Jacob Dugger (speaker) Micki Nozaki If you registered and Tatiana Fassieux Bill Nugent* your name does not Glenn Ferry (speaker) Brent Person appear, contact Jasmine Aileen Fisher Claire Pisching Karen Fletcher Doug Shaw* Janet Frank Sheila Reed Stark Lupe Garcia Marsha Stolzoff Paula Holden Jasmine Suo Michael Ito Rachel Tate Albert Lucchessi* Evelyn Taylor Judy Lynch Carolynn Washington *Need Conference Registration 18

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20 Tuesday April 25, :00 am - 8:30 am Breakfast and Introductions 8:30 am 10:00 am Session 1: HOT FRAUD CASES and SMP PARTNERSHIP Brent Person WITH CMS AND THE ZPIC CMS Program Integrity Jake Duggard SafeGuard Services, LLC 10:00 am - 10:15 am Session 2: OPEN DISCUSSION ABOUT FRAUD CASES Reflections of speakers & information 10:15 am - 10:30 am BREAK and check out of hotel 10:30 am 11:45 am Session 3: A NEW FRAUD SKIT BY THE SMP PLAYERS Karen Fletcher & Media Team 11:45 am- noon Session 4: SMP Resources Accessing SMP materials Noon Working Lunch Session 5: Dissecting Cases and Cross Reporting 1:00 pm 1:15 pm Session 6: SMP Updates & OIG Report 1:15 pm 2:25 pm Session 7: Outreach Panel & Roundtable SMP Liaisons (5-10 min each) 2:15 pm 3:25 pm Session 8: Case Panel & Roundtable SMP Liaisons (10-15 min each) 3:25 pm- 3:45 pm Session 9: OPEN 3:45 pm- 4:00 pm Conference Wrap-Up and snack 4:00 pm End 20

21 Open Mic 21