SMP Liaison Linked Up Webinar - California Health Advocates
SMP Liaison Linked Up Webinar March 9, 2017 Funded by the U.S. Department of Health & Human Services - Administration on Community Living / Administration on Aging Warm Welcome Dalila Miller, SMP Liaison with Kings/Tulare HICAP Albert Lucchesi, SMP Liaison with Stanislaus HICAP Lupe Garcia SMP Liaison with Kern County HICAP 2
Agenda Cases Media & PR SMP Business SMP April 2017 Conference Schedule for webinars Open Mic 3 FEBRUARY CASES 4.5 4 4 3.5 3 2.5 2 1.5
1 0.5 3 3 2 1 1 1 0 15 cases in total, 6 from SMP Partners 1/15 from Tamara McKee, Monterey HICAP 2/15 from Linda Chavez, SMP Liaison and RSVP Director 3/15 from Maria Nava, Merced HICAP 1
1 9 4 Closed-Action taken by referent Referred to the CA Board of Pharmacy Referred to the ACL, OIG contact, and Centers for Program Integrity Referred to the Dept. of Managed Health Care 4 CASES OUTREACH 5 Linda Chavez, RSVP Director and SMP Liaison cold call from call someone at Loyalton Pharmacy (701 Main St., Loyalton, CA 96118, phone number 844-313-5879) asked by this unknown caller about -pain and medications -name of his primary care doctor -his Medicare number, but the beneficiary did not disclose this
beneficiary received a package from Loyalton Pharmacy, but he did not open the package SMP referred this case to the MEDIC and CA State Board of Pharmacy SMP also contacted SCAN HMO at 800-559-3500. SCAN representative took a report and said they would be opening a fraud investigation. The call reference number is 1967333. Board of Pharmacy contact agreed to open an investigation on Loyalton Pharmacy, PHY 54562, saying the pharmacy should not be sending prescriptions to the patient or collecting the patients information without their consent. Further investigation would be needed to see exactly what was going on. 6 Maria Nava, Merced HICAP Program Manager two beneficiaries who were unknowingly enrolled into Secure Horizon HMO their doctors do not take the plan beneficiaries do not know they were placed into this HMO HICAP assisted both beneficiaries and were able to retro the enrollment back into Original Medicare SMP reached out to the beneficiaries to ask additional
questions. One beneficiary claims she did not meet with anyone, except for HICAP, and she is adamant that she did not receive a phone call, home visit, nor mail pertaining to Secure Horizons. The other beneficiary provided SMP with a copy of a letter she received from the HMO. These cases were referred to the Dept. of Managed Health Care 7 Tamara McKee, HICAP Program Manager of Alliance on Aging beneficiary paid $50 for portal services to her doctor SMP reported the letter to Carolyn Cahn with CMS Reg. IX. Per Carolyn: -Can't charge for emergency calls, prescription calls, prior authorizations -I reviewed what is allowable. They will update the form to ensure that they exclude certain items so that it will be Medicare compliant. She was most appreciative that I was willing to assist to keep them compliant (versus giving them problems)
8 9 10 Another example of a concierge letter with some questionable charges: Per Carolyn Cahn of CMS Reg IX: There are major concerns with what the office is charging for. Most items cannot be charged to a Medicare beneficiary. Pre-op evals They cannot bill for this unless it is for elective noncovered procedures (like a tummy tuck) Paperwork for non-Medicare services are fine, but otherwise they cannot charge Administrative forms most they cannot charge for. They can charge for record copies per the identified schedule. Keep same-day slots no must offer all appointments to every bene Phone consultations OK as we do not cover this Electronic consults OK as we dont cover this Non-covered Rx NO! Just because Medicare does not cover it!!!! No they cannot do this!!!! Carolyn Cahn later informed SMP about her contact with the
providers office: I called the office. I explained that the office cannot charge for most of the items on the list. She said that they can. I explained that this is a participation violation, and she stated it wasnt. I told her that she failed to call me back, and she stated that it has not been 24 hours. When I explained that I called on Friday so it has been more than 24 hours she hung up. Carolyn referred this 11 12 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. 13
14 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 its 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
SMP Liaison/Volunteer Role: -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 Countys HICAP volunteer counselors about Medicare fraud at inservice 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 2nd 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 timesheet (due the 15th of the following month) monthly Publications & Media Update
March Medicare Minute Medicare Coverage of Hospital Visits Access MMs on the SMP Resource website Recent Articles, Blogs & Alerts Call Today! Tell Congress No to Medicaid Cuts & Yes to Protecting Our Elders Will New MOONs Shed Light on Midnight Madness? Equitable Relief Waives Part B Penalties for Qualified Beneficiaries Military Scam Offers to Pay for Burial Costs Stop Senior Scams Acting Program Does It Again ~ Preventing Fraud through Skits, Humor & Smiles What Does the Uncertain Future of the Affordable Care Act Mean for Californians? Do You Qualify for a Special Enrollment Period? 17
Publications & Media Update New Medicare Fraud Alert will be posted soon New Medicare Cards Coming in 2018 ~ Beware of Scams Call to collect Medicare & HICAP testimonials & stories. Help show the faces of Medicare and HICAP We'd like to put a personal face to California's Medicare beneficiaries and those who benefit from HICAP. These stories/testimonials will be used on our website, in advocacy letters, articles and possibly in any written or oral testimonies. If you have a success story to share, email me. If you have a client willing to share his/her experience with Medicare and how it enhances their life, email me.
Happy Spring all!or We look forward to seeing you in April! You can also sendto video written statements. 18 Time Sheets/Community Ed/Media Reports for February Timesheets/Reports received as of Today 3/9 Karen Fletcher Sandy Howell Katharine Raley Michael Ito
Linda Chavez Genesis Sanchez Abe Wischnia Richard Woodward Judi McCarter Claire Pisching Paula Holden Sarah Barnard Ray Jones Gene Campbell No Time to Report
Barbara Long Elizabeth Gutierrez (Partner) Ellise Hanson Christina Garcia (Partner) David/Joyce Rugeroni Evelyn Taylor Its not too late to send them in! SMP Business Update Jasmine Suo [email protected] Monthly SMP Liaison Timesheets SMP Partner Outreach Hours
Title: Medicare Part D and the Details You Need to Know to Best Assist Beneficiaries Speaker:Rajul Patel, Pharm.D., Ph.D. Time: 10:00 a.m. 11:30 a.m. (Bonus Webinar) (4th Thursday Educational Webinar) Title: Recruiting, Training and Working with Hispanic Volunteers Speaker: Maria Hernandez-Lane from the National Hispanic
Council on Aging Time: 10:00 a.m. 11:30 a.m. Title: TBD Speaker: Connie Alarcon, Better Business Bureau Upcoming SMP Partner Call: March 16th at 9:30 a.m. SMP Spring Conference April 25, 2017 Wyndham Hotel Irvine, CA Conference Registrations Received Gene Campbell Aileen Fisher Janet Frank
Michael Ito Marian Last Judi Lynch Claire Pisching Sheila Reed Stark Marsha Stolzoff Carolynn Washington Richard Woodward Pat Macholl
Albert Lucchessi*** Sandy Morales Micki Nozaki Tatiana Fassieux Paula Holden Dalila Miller*** Karen Fletcher Renato De Moraes Jasmine Suo Lupe Garcia *** Hotel Reservation only, need Conference Registration
22 Tuesday April 25, 2017 - Agenda 8:00 am - 8:30 am Breakfast and Introductions 8:30 am 10:00 am Brent Person CMS Program Integrity Jake Duggard SafeGuard Services, LLC Session 1 HOT FRAUD CASES and SMP PARTNERSHIP WITH CMS AND THE ZPIC 10:00 am - 10:30 am Reflections of speakers & information Session 2 10:30 am - 10:45 am
BREAK and check out of hotel 10:45 am 11:15 am Karen Fletcher Media Updates Session 3 A NEW FRAUD SKIT BY THE SMP PLAYERS 11:15 am noon SMP Roundtable (Liaison presentations) Session 4 Noon OPEN DISCUSSION ABOUT FRAUD CASES Working Lunch (open) 1:00 pm 1:15 pm
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