COMPLIANCE NEWSLETTER FOR MEMBERS 2014 CARE1ST COMPLIANCE: DEDICATED TO YOU Dear Care1st member: At Care1st we have a motto: Yes, it s all about you. We strive to serve you, our member, and one of the ways we do this is by running an ethical company that follows the law and respects your dignity. Care1st staff members have pledged to respect your privacy and ensure that fraud, waste and abuse are absent from this health plan. Having had the privilege of being the Care1st corporate compliance officer for the last 15 years, I am very proud to introduce the first edition of our new Compliance Newsletter for Members. This new newsletter not only highlights what we at Care1st are doing to serve you better, but it also contains important information related to fraud, waste, abuse and privacy issues while providing the opportunity for you to assist us in giving you the respect you deserve and in locating and eliminating fraud and other practices that could interfere with your receiving your full Care1st benefits and services. How Care1st Compliance protects you Care1st has a responsibility to fight fraud, waste and abuse. This task extends to helping you, our member. An example of this protection is a call I recently received from a Care1st member I will call Mary. She went to her local drugstore to pick up her monthly prescription, but the pharmacist refused to give her the medicine, noting it had already been distributed. She contacted Care1st. We learned that recently her purse had been stolen and in that purse was her driver s license, along with the expensive drugs she needed to take every day. We subsequently learned that the thief had used the information on the label of the drug to order a refill and then used the stolen license as identification to pick up the drug. Because the drugstore had surveillance cameras, law enforcement was able to identify the imposter who picked up the prescription, and he is now in prison. Mary was able to get her necessary medicine. We were happy to assist Mary. We do urge you to be careful with the labels on any drugs you may have, since they can be used by a thief to obtain them from a drugstore. In addition, if you have information that anyone is stealing your identity to make use of your Care1st membership, please contact my office immediately. Not only will we work with the police to catch the imposter stealing your benefits, but we will also make sure such thefts don t hurt your ability to obtain necessary health care services. Brooks Jones, CHC Corporate Compliance and Privacy Officer The Care1st fraud hotline is 877-837-6057.
2 2014 Compliance Newsletter for Members WE SPEAK YOUR LANGUAGE Care1st wants to make sure that you can speak to your doctor and medical staff in your language, including American Sign Language. If your doctor does not speak your language, you have the right to: Ask Care1st or your doctor for an interpreter at no cost to you. Receive interpreting services 24 hours a day, 7 days a week. This means interpreting services are also available to you after normal business hours. By law, your doctor cannot: Ask you to bring your own interpreter or pay for an interpreter. Use your child to interpret for you. Refuse or delay medical care services because you do not speak English or do not speak it well. As a Care1st member, you also have the right to: Get notices about your benefits in your language and in alternative formats, such as Braille, large print or audio. Get health education brochures in your language and in alternative formats. Get written informing materials in your language and in alternative formats. Be referred to community agencies that offer culturally sensitive services. File a grievance if we do not meet your language needs. We can help If you need a free interpreter for your next doctor s visit, please call the Care1st Member Services Department at 800-605-2556 at least seven days before your appointment. We offer our members a directory of community resources and agencies. It has information on organizations near you that can help you with issues such as domestic violence and elder care. The directory also lists organizations that offer counseling services, social services and interpreter services. You can get health information, learn more about your member benefits and learn how to file a grievance on our website, www.care1st.com. Information is available in various languages. Members with vision impairment can use the magnification tool on the website to make the text easier to see. Contact us If you need further assistance, please contact the Cultural and Linguistic Department at 800-605-2556. You can also send an email to thorth@care1st.com. Jorge Weingarten, MD Chief Medical Officer CARE1ST HEALTH PLAN CARES is published for members of CARE1ST HEALTH PLAN, 601 Potrero Grande Drive, Monterey Park, CA 91755, www.care1st.com, telephone 323-889-6638, 800-605-2556 (TTY: 711). H5928_14_421_COMPL Accepted Care1st Health Plan is an HMO plan with a Medicare contract. Enrollment in Care1st Health Plan depends on contract renewal. CARE1ST is an affiliate of LA Care Health Plan in providing Medi-Cal managed care services in Los Angeles County. Copyright 2014 Coffey Communications CUN30418
www.care1st.com 3 FRAUD ALERT: MEDICAL SUPPLIES IN THE MAIL Did you know? Neither Medicare nor Medicaid (Medi-Cal) sells or mails medical supplies. If you receive medical supplies that you or your doctor did not order, you might be the target of a fraud scheme. Take action to protect your Medicare/Medicaid (Medi-Cal) benefits: Refuse medical supplies you did not order. Return unordered medical supplies that are shipped to your home. Report companies that send you these items. Do your part You can protect your identity and your benefits: Never give out your Social Security, Medicare, Medi-Cal, or health plan numbers or banking information to someone you don t know. Carefully review your Plan Statement to ensure all the information is correct. Know that free services DO NOT require you give your plan, Medi-Cal or Medicare number to anyone. Share this information with your friends. To discuss benefit, coverage or claims payment concerns, contact Member Services at 800-544-0088 (Medicare), 800-605-2556 (Medi-Cal), 855-905-3825 (Cal MediConnect), or TTY 711. Source: Centers for Medicare & Medicaid Services Take charge of your health Your doctor is your partner in helping you stay healthy. He or she has free pamphlets on many health topics. Ask your doctor or call Care1st if you d like to get any of these pamphlets. You can also get free health information by going to our website at www.care1st.com. Living Well Information Line We offer an information line to answer your questions about cholesterol, weight management, exercise, nutrition and diabetes. Please call Care1st Member Services. Ask to speak with Linda Fleischman or Rosa Hernández. Free weight management classes To help you and your family stay healthy, we offer adult, teen and child weight management classes. We offer these classes at our resource center in Huntington Park. To find out when the next series begins, please call Care1st Member Services.
4 2014 Compliance Newsletter for Members BREASTFEEDING YOUR BABY: A HEALTHY CHOICE Did you know that the number of mothers choosing to breastfeed has grown steadily in the last 10 years? Breast milk is becoming the recommended choice for nourishment of newborns and infants everywhere. Why? It is often called the first food. And there are a lot of good health benefits for both the mom and baby. Here are just a few of them. BEFORE YOU START EXERCISING Breast milk is good for your baby It has all the nutrients your baby needs. It is easy to digest. It helps to protect your baby from many illnesses. Breastfeeding is good for you It helps you recover from giving birth. It saves you money and time. It gives you time to enjoy your baby. If you need help getting started, talk to your doctor. You can also call WIC (Women, Infants and Children) at 888-942-2229. This is a free call. People of all ages can benefit from staying active. But check with your doctor before starting an exercise program if you: Are older than 50 and not used to being active. Have recently had hip surgery. Have dizziness or shortness of breath. Have a chronic condition, such as diabetes or heart disease. For most older adults, brisk walking, bike riding and swimming are safe activities. Whatever you do, pace yourself and increase your activities slowly. Unless your doctor tells you to limit your fluid intake, drink plenty of water. You may be a little tired or sore after exercising, but you should never feel pain. Stop the activity and call your doctor if you feel pain or pressure in your chest, arms or jaw; feel light-headed or short of breath; or feel pain developing in your legs, calves or back. Source: National Institute on Aging
www.care1st.com 5 HIPAA OUR COMMITMENT TO YOUR PRIVACY Your health is personal. That s why we work hard to protect your information. It s our policy and practice. It s also the law. There is a federal law called the Health Insurance Portability and Accountability Act (HIPAA). This law gives you rights over your records. It applies to many providers and programs, including most: Doctors. Nurses. Pharmacists. Hospitals. Health plans. This law also applies to Medicare and Medicaid. Because of HIPAA, you can: Ask to see and get a copy of your health records. You can do this even if you haven t paid your bill. Add corrections to your health records. Ask that certain people not be given details about your health or treatment. Decide if you want to let your health information be used for certain purposes, such as marketing. Get a report on when and why your information was shared or used. File a complaint if you think your rights or privacy have been violated. HIPAA spells out other rights too. For example, you can ask to be contacted at a place other than at home. For instance, you can ask to get test results at work. Why we might share records There are some good and approved reasons to use or share health information. We may need it: To follow the law. For instance, we may need to report flu and other public health risks. For coordinating your treatment and care. To pay providers. For checking out the quality of treatment, providers and institutions. Still, your health information can t be used or shared without your written permission. This can only happen if HIPAA allows it. Always on alert We protect your private health information. It matters to you. And it matters to us. We can answer any questions you might have about: Your rights. Our responsibilities. The steps we take to keep your information safe. If you suspect that your privacy has been violated or if you have questions: Call Care1st s hotline number at 877-837-6057. Email us at compliancesiu@ care1st.com. Contact our privacy and corporate compliance officer, Brooks Jones, CHC, at 323-889-6638. Or contact the Department of Health Care Services (DHCS) privacy officer: Email: privacyofficer@ dhcs.ca.gov. Phone: 916-445-4646. Fax: 916-440-7680. Address: C/O Office of HIPAA Compliance DHCS, P.O. Box 997413, MS 4722, Sacramento, CA 95899-7413. Website: www.privacy.ca.gov. For our Notice of Privacy Practices (NPP), please go to www.care1st.com/media/ pdf/medi-cal/care1stnpp LosAngeles.pdf.
6 2014 Compliance Newsletter for Members DID YOU KNOW? Identity theft: Be aware of these schemes Identity theft impacts Medicare/Medicaid (or Medi-Cal) and can lead to higher health care costs. Don t let anybody steal your identity. Current fraud schemes to be on the lookout for include: People using your Medicare/Medi-Cal or health plan member number for reimbursements of services you never received. People calling you to ask for your Medicare/Medi-Cal or health plan numbers. People trying to bribe you to use a doctor you don t know to get services you may not need. Protecting future generations Did you know that reducing Medicare and Medi-Cal fraud is one step towards making sure your grandchildren will have Medicare and/or Medi-Cal when they need it? You can do your part by being on the lookout for fraudulent schemes such as: People going door to door to sell you health care items or services (only your doctor knows what you need). People calling you to ask for your Medicare, Medi-Cal or health plan numbers. People offering you money or other incentives for health care services you don t need. Always check your bill You are one of the first lines of defense against Medicare and Medi-Cal fraud. Do your part and report services or items that you have been billed for but did not receive. Review your plan statement and be on the lookout for this scheme. Make sure you received the services or items billed. Check the number of services billed. Ensure the same service has not been billed more than once. Source: Centers for Medicare & Medicaid Services DO YOUR PART You can protect your identity and your benefits: Never give out your Social Security, Medicare, Medi-Cal, or health plan numbers or banking information to someone you don t know. Carefully review your Plan Statement to ensure all the information is correct. Know that free services DO NOT require you give your plan, Medi-Cal or Medicare number to anyone. Share this information with your friends. To discuss benefit, coverage or claims payment concerns, contact Member Services at 800-544-0088 (Medicare), 800-605-2556 (Medi-Cal), 855-905-3825 (Cal MediConnect), or TTY 711.
www.care1st.com 7 What to do if you suspect fraud or privacy violation If you suspect compliance, ethics or integrity violations or have questions about specific practices, please use the following resources. Contact Care1st Call the Care1st hotline at 877-837-6057. It s toll-free, anonymous, available 24/7 and operated by trained professionals. Email the Compliance Department at compliancesiu@care1st.com. Call the corporate compliance officer, Brooks Jones, at 323-889-6638. Call the Care1st Member Services Department: 800-544-0088 (Medicare), 8 a.m. to 8 p.m., 7 days a week. 800-605-2556 (Medi-Cal), 8 a.m.. to 6 p.m., Monday through Friday. 855-905-3825 (Cal MediConnect), 8 a.m. to 8 p.m., 7 days a week. TTY 711 hours are same as above. You may also use the Medi-Cal Fraud Hotline Call 800-822-6222. Email stopmedicalfraud@dhcs.ca.gov. The Department of Health Care Services (DHCS) asks that anyone who observes or has knowledge of suspicious health care activity call the DHCS Medi-Cal Fraud Hotline tele- phone number, 800-822-6222, to report it. The recorded message may be heard in English and four other languages: Span- ish, Vietnamese, Cambodian and Rus- sian. The call is free, and the caller may remain anonymous. You can also email stopmedicalfraud@dhcs.ca.gov.
8 2014 Compliance Newsletter for Members STOP MEDICARE FRAUD Deter Protect your personal information. Guard your Medicare and Social Security numbers. Treat them like you would treat your credit cards. If it s free, they don t need your number! Be suspicious of anyone who offers you free medical equipment or services and then requests your Medicare number. It s illegal, and it s not worth it! Do not let anyone borrow or pay to use your Medicare ID card or your identity. Detect Watch out for these common fraud schemes. Just walk away if people approach you in parking lots, shopping centers or other public areas and offer free services, groceries, transportation or other items in exchange for your Medicare number. Simply hang up the phone if someone calls you claiming to be conducting a health survey and asks for your Medicare number. Don t give your information to telephone marketers who claim to be from Medicare or Social Security and ask for payment over the phone or Internet. They may want to steal your money. Source: Office of Inspector General Medicare: Who to contact Contact Care1st Health Plan Call the hotline number at Send email to 877-837-6057. compliancesiu@care1st.com. Or call the National Benefit Integrity (NBI) Medicare Drug Integrity Contractor (MEDIC) at 877-7SAFERX (877-772-3379). You may also contact: Department of Health & Human Services Office of Inspector General Hotline Report suspected Medicare fraud: Phone: 800-447-8477 (800-HHS-TIPS). TTY: 800-377-4950. Fax: 800-223-8164. Email: HHSTips@oig.hhs.gov. Online: oig.hhs.gov/fraud/hotline. Medicare Call Center and SMPs Report questionable charges to Medicare: Phone: 800-633-4227 TTY: 877-486-2048. (800-MEDICARE). Online: www.medicare.gov. You can also contact your local SMP: SMPs (Senior Medicare Patrols) work locally to empower seniors to fight health care fraud and resolve errors. Find an SMP in your area. Go to www.smpresource.org or call 877-808-2468. If your Medicare card is lost or stolen, report it right away. Call Social Security at 800-772-1213 (TTY: 800-325-0778) for a replacement. Federal Trade Commission s Identity Theft Hotline Report misuse of your personal information: Phone: 877-438-4338 (877-ID-THEFT). TTY: 866-653-4261. Online: FTC.gov/idtheft.