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Presented  by Statewide Health Insurance Benefits Advisors (SHIBA), Washington state’s Presented  by Statewide Health Insurance Benefits Advisors (SHIBA), Washington state’s

Presented by Statewide Health Insurance Benefits Advisors (SHIBA), Washington state’s - PowerPoint Presentation

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Uploaded On 2019-11-05

Presented by Statewide Health Insurance Benefits Advisors (SHIBA), Washington state’s - PPT Presentation

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

fraud medicare health smp medicare fraud smp health report services care information step detect billing prevent abuse www suspected

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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