funded by the u.s. department of health & human services ... · 5/6/2016 · october 13, 2016...
TRANSCRIPT
Funded by the U.S. Department of Health & Human Services - Administration on Community Living / Administration on Aging
Cases Media & PR SMP Business SMP September 2017 Conference Schedule for webinars Open Mic
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11 cases in total 3 from SMP Liaisons: 1/11 Ellise Hanson, SMP Liaison-Butte, Colusa, Glenn, Plumas, Tehama, PSA 3 HICAP 1/11 Gene Campbell, SMP Liaison-Orange HICAP 1/11 Aileen Fisher, SMP Liaison-San Mateo HICAP
4/11 Under SMP Review 4/11 Referred to the ACL 2/11 Referred to the Dept. of Managed Health Care 1/11 Referred to Tangita Daramola, Competitive Acquisition Ombudsman, US Department of Health and Human Services-CMS
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CASES… OUTREACH…
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Gene Campbell, Orange County SMP Liaison: - Beneficiary received a postcard from the Joint and Back Institute - Responded and called the number on the postcard, eventually disclosing his Medicare number. - Beneficiary said a representative with the company wanted to come to his
home to measure him and/or his wife for brace(s).
Aileen Fisher, San Mateo SMP Liaison: -Beneficiary gave her Medicare number to a caller claiming to be from Pro-Card Pain Clinic. Ellise Hanson, SMP Liaison-Butte, Colusa, Glenn, Plumas, Tehama, PSA 3 HICAP: -Possible illegal sale of an out-of-state Medicare Advantage plan sold to a beneficiary Per SMP liaison's note: Beneficiary contacted HICAP after being unable to find service providers who would take her insurance. HICAP contacted client by phone and advised her that MA plan sold to her by Fraudulent Company of Houston Texas was not valid and it was not legal for them to sell it to her. Told her we would follow up on the issue with the agency that sold her the plan.
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Sandy Morales, CHA-SMP: -Beneficiary was switched into a different HMO without her authorization. -She received a call from Mr. Greedy Agent, who claimed to be calling on behalf of her HMO broker, saying that broker no longer works there, so he’s following up. -Mr. Greedy Agent said he can provide her with better benefits that include better doctors and access to a gym. -The beneficiary informed Mr. Greedy Agent that she was not too happy with her current doctor and Mr. Greedy Agent said they had better doctors and he had found one for her. -The call ended with Mr. Greedy Agent providing his callback phone number and beneficiary understanding that he had found a doctor for her. It was not until the beneficiary received a letter from a different HMO plan that she realized she had been changed into a different plan without her authorization. -Concerned about this, beneficiary called her original HMO plan her and told them she wanted to remain with them. -Beneficiary attempted to contact Mr. Greedy Agent, but was never able to get in contact with him. -Beneficiary decided to contact former HMO broker to determine whether or not he was still employed with the HMO Plan. According to the beneficiary, this person replied that he was still with the HMO and believes he may know Mr. Greedy Agent, saying they used to work together and he believes Mr. Greedy Agent may have taken client information when he left. -SMP called Mr. Greedy Agent. He introduced himself as Mr. Greedy Agent with Medicare Union. When asked who they are and what they do, he stated they sell Medicare Advantage plans and supplement plans and are a Medicare brokerage. When SMP asked him if he was a licensed agent, he replied yes. When SMP asked him for his CA license number, Mr. Greedy Agent hung up.
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Abe Wischnia, Santa Clara SMP Liaison: A tip you might want to pass on to the other SMPs: As I pack up after giving a presentation, while the facility coordinator is still upbeat about the way the event went, I mention that I can come back at a later date to cover other aspects. In this case, in connection with the AEP. I've done that twice now and both times resulted in the return invitations. Doug Shaw, CHA Vice Chair and SMP Southern CA Regional Liaison: -Outreach to mobile home communities
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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.
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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.
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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 1-800 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: 855-613-7080 E-mail: [email protected]
*Home office: 951-282-3960 No voicemail set-up
Steps: Handling Complex Cases
-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 4th
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 15th of the following month)
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Publications & Media Update
May Medicare Minute
◦ Medicare Savings Programs (MSPs)
◦ Access MMs on the SMP Resource website
Recent Articles, Blogs & Alerts
◦ CDA Solicits Comments on California’s State Plan on Aging
◦ National Volunteer Spotlight Falls on SMP Volunteer, Gary Molina!
◦ House Passes AHCA ~ Takes Away Health Care Protections & Affordability from Millions of Americans
◦ Why You’re Getting a New Medicare Card & Scams to Watch Out For
◦ Bonnie Burns Testifies on Consumer Concerns Regarding PennTreaty’s Liquidation Long-Term Care Policies
◦ CHA Supports Gleason Enduring Voices Act of 2017 ~ Ensuring Medicare Coverage of Speech Generative Devices
◦ The ACA Repeal Bill is Back ~ Call Congress & Say NO
◦ How Does Medicare Work with Current Employee Insurance?
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Publications & Media Update
Review of our SMP Liaison Help page
◦ To find it, go to the search function and type in “SMP liaison help”. This page will come up.
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Publications & Media Update A personal share – some good news!
◦ Some of you know, but I meant to share with everyone at the conference that… I’m pregnant!
◦ I’m 19 weeks and supposedly my baby is as big as a large heirloom tomato this week
Happy Late Spring and Beginnings of Summer to you all!
Save the date: Next SMP Conference will be in Sacramento
between September 12-14. SMP will be
sharing a day with CDA, which means that HICAP Program Managers and SMP Liaisons will be together during the first day of the conference. More details to come.
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SMP 4th Thursday Educational webinars o Thursday, May 25, 2017, 10 a.m. – 11:30 a.m.:
“More Than Just A Band-Aid” with Connie Alarcon, Better Business Bureau
o Thursday, June 22, 2017, 10 a.m. – 11:30 a.m.: Michael Corby, Cybercrime and Ransomware
National SMP Resource Center (www.smpresource.org) upcoming webinars:
o Wednesday, May 31, 2017, 10:30 a.m -noon Pacific Time: The Beneficiary and Family-Centered Care Quality Improvement Organization Webinar
o Thursday, June 15, 2017, 10:00 a.m. -11:00 a.m. Pacific Time: Storytelling 101 Webinar: This webinar will provide an introduction on storytelling as a tool for communication and education. During this webinar, you’ll learn why storytelling is important and how storytelling can help you educate beneficiaries about the SMP mission in your conversations and presentations and connect them to the services of the SMP program. Anyone in the SMP network who is interested in this topic is welcome to attend. SHIP (State Health Insurance Assistance Program) and MIPPA (Medicare Improvements for Patients and Providers Act) grantees are also invited to this webinar.
SMP Partner Call: May 18th at 9:30 a.m.
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Open Mic