Presented by Statewide Health Insurance Benefits Advisors SHIBA Washington states SMP SMP program funded by the US Administration for Community Living Take Charge Help Prevent Health Care Fraud and Abuse ID: 763571
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Presented by Statewide Health Insurance Benefits Advisors (SHIBA), Washington state’s SMP SMP program funded by the U.S. Administration for Community Living Take Charge… Help Prevent Health Care Fraud and Abuse!
Medicare Fraud, Errors, and Abuse Affect…EveryoneBillions of taxpayer dollars lost to improper claimsMedicare trust fund at riskMedicare BeneficiariesHigher premiumsLess money for needed benefitsQuality of treatment2
Consequences of Medicare Fraud, Errors, and Abuse3
What is the Senior Medicare Patrol?4
What is Medicare Fraud? Intentionally billing Medicare for services that were not received or billing for a service at a higher rate than is actually justified5
What is Medicare Abuse? Providers supply services or products that are not medically necessary or that do not meet professional standards6
Examples of Fraud & Abuse7
Three Steps to Prevent Health Care FraudProtect 2) Detect 3) Report 8
Step 1: Protect Yourself and Others from Medicare Fraud9
Step 2: Detect Medicare Fraud & AbuseTrack medical appointments on your calendar or get a Personal Health Care JournalReview Medicare Summary Notices (MSNs) and other statements for: 1. Services you didn’t receive 2. Double-billing 3. Services not ordered by your doctorAccess your Medicare information at www.MyMedicare.gov. 10
Step 3: Report Suspected Medicare Fraud and AbuseCall the provider.Gather information and documentation.Contact your SMP. This is a free and confidential service!11
Three Steps to Prevent Health Care FraudProtect 2) Detect 3) Report 12
Contact your state SMP: SHIBAVisit us online: www.insurance.wa.govFor more information Call toll-free: 1-800-562-6900To report suspected fraud/abuseFor training, speakers, and/or materialsTo volunteer with the SMP program13