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Do you have comments or concerns about your Medicare coverage? Issues regarding getting your needed prescriptions from your Part D plan, or a Medicare Advantage plan representative's marketing practices? Let us know at .

We are dedicated to making Medicare's program work well for all beneficiaries. Your feedback from your own or your client's concerns and experiences with Medicare, will guide our Medicare advocacy efforts with key policy and decision-makers in both California and nationally with the Centers for Medicare and Medicaid Services (CMS) and Congress.

  • 14Apr

    See one of own Senior Medicare Patrol Liaisons, Jane Knapel in action. In this half hour video segment Jane introduces SMP, what we do and speaks on various types of Medicare fraud. She shares fraud examples from her own recent cases, including those involving cold callers and beneficiaries receiving unwanted and unordered durable medical equipment. In one example a woman received 5 wheelchairs, none of which were ordered or necessary.

    She also clarifies the difference between a person’s Medicare number being compromised and a credit card. While you can get a new credit card number if it has been stolen or misused, that is not the case with Medicare. Your Medicare number remains the same even if it gets compromised. And once a number has been compromised, it can happen again,…and again. In such a case, benefits that you may need in future may not be available. They may have already given to someone else without you knowing about it.

    Jane addresses the Affordable Care Act as well and the host of new fraud schemes that are arising, especially last fall with the confusion around the overlap of Medicare’s open enrollment period and the open enrollment for the new health care exchanges.

    View the video of last fall’s Senior Scam Seminar in Millbrae to hear Jane’s full presentation. Also, visit our Medicare Fraud section for more info on healthcare fraud.

  • 07Apr

    In this 22-minute video below, the Office of Inspector General’s (OIG) leadership discuss their priorities in 2014, including how the OIG will fight fraud, waste and abuse, promote quality, safety and value while ensuring the future of Health and Human Services programs.

    OIG oversees the complex world of the government’s health care programs, and their 2014 work plan provides the blue print of their oversight and enforcement efforts. As it is a time of great transition, a good portion of oversight is focused on the new health care market places, particularly on:

    • Payment accuracy
    • Eligibility controls
    • Contracting oversight and
    • Privacy and security issues

    In the short video, the OIG elaborates on their goals for 2014 and beyond, including:

    • Fighting fraud waste and abuse — such as prescription drug fraud and fraud in home and community-based services.
    • Promoting quality, safety and value. A key focus is on the quality of care in nursing homes and addressing the unacceptable reality of how often beneficiaries are injured or harmed during their nursing home stays.
    • Securing the future of Health and Human Services programs, of which Health IT is big priority.

    See the video below and read the OIG’s 2014 Work Plan (pdf) for more information.

  • 02Apr

    The infographic below effectively highlights some of the failures of our own health care system. While the U.S. has some of the highest health care costs, it is not even ranked in the top 50 countries for life expectancy. This begs the important question of: “If all this money being spent is not being used to increase quality of life or life expectancy, then where is it going?”  The infographic, contributed by Best Nursing Masters, concludes with identifying some of the common traits found in the residents of countries with the highest life expectancy, and encourages people to turn away from looking for a “cure” for symptoms, and instead to focus on developing healthy lifestyles.

    Healthcare Spending
    Source: BestNursingMasters.com

  • 26Mar

    Great news! The amount of funds recovered to Medicare for fraudulent claims that is attributed to cases our California Senior Medicare Patrol (SMP) closed in 2013 totals over $7 million. These closed cases range from 2007 to 2012. This success is a direct result of all the efforts and commitment of our dedicated staff and SMP volunteers. A big thank you to all our volunteers and partnering colleagues for  your great service in helping restore integrity to our Medicare program. These numbers are in the 2013 Office of Inspector General (OIG) report.

    The national numbers highlighted in the OIG report’s press release are also equally impressive with government teams combined recovering a record $4.3 billion for FY 2013, and $19.2 billion over the past 5 years. This last figure is up from $9.4 billion in the 5 years before that. Since it began in 1997, the Health Care Fraud and Abuse Control (HCFAC) Program has returned more than $25.9 billion to the Medicare Trust Funds and treasury.

    The report also demonstrates that for every dollar spent on health care-related fraud and abuse investigations in the last 3 years, the government recovered $8.10.  This is the highest 3-year average return on investment in the 17-year history of the HCFAC Program.

    These record recoveries demonstrate President Obama’s commitment to making the elimination of fraud, waste and abuse, particularly in health care, a top priority for the administration.  This is the 5th consecutive year that the program has increased recoveries over the past year, rising from $2 billion in FY 2008 to over $4 billion every year since FY 2011.

    For more information, see both the OIG 2013 report and the press release.

  • 19Mar

    It can be challenging for elders living on a fixed income to eat well. Yet, healthy nutrition is essential to prevent illness, and to maintain an active and independent life. The National Council on Aging recently put together 3 short videos on how to get help paying for food, ways to shop smart, and tips to make comfort foods healthier. Please view and share with your clients and loved ones.

    Elders with low-incomes, can also visit NCOA’s BenefitsCheckUp website to download their state’s application for food assistance.

  • 13Mar

    Here’s a short video from the Kaiser Family Foundation on the Centers for Medicare and Medicaid Services’ proposed changes to the Part D prescription drug benefit. Currently CMS requires Part D plans to cover the vast majority of drugs in 6 specific classes. One proposed change is to drop 2 of these categories next year (anti-depressants and immunosuppressant drugs) and then drop anti-pyschotics a year later. Several advocacy groups are concerned that this change would reduce people’s access and ability to get the drugs they require. They point out that not all drugs are the same and it’s important to have a wide range of drugs available. Another proposal is to limit the number of plans each plan sponsor can offer. Research shows that more choices aren’t necessarily better for seniors; it can actually be more overwhelming. Many beneficiaries tend to stick with a plan they originally pick.

    Watch the short video below for more information on these changes…

  • 04Mar

    Below is an infographic with some disturbing facts about the cost and numbers of prescriptions Americans are taking. This article, Pill Nation: Are Americans Over Medicated? is provided by The Nursing Bible blog.


    Pill Nation

  • 25Feb

    We continue to receive reports of new phone scams. Yet while the “title” of the scam may change, the fundamental tactics are the same. Below is a warning of two recent scams reported to us this month, followed by a list of common tactics. This list provides a helpful reminder of what to watch out for to protect yourself from fraud and to report it when encountered.

    Two Recent Scams:

    New Medicare benefits phone scam: In this scam, a caller claims to be a Medicare representative and wants you to know all about Medicare’s new and improved benefits. The caller than asks you to verify your Medicare number, primary physician information and current health conditions. Remember, Medicare will never call you to report on new benefits, AND will not ask you for your personal information. Medicare already has it. Hang up and report this number to our Senior Medicare Patrol (SMP) helpline at 855-613-7080.)

    Medical device alert robocall phone scam: In this scam, a beneficiary receives a call from recording (also referred to as a “robocall”) which says, “You have been recommended to receive this device by a physician … dial 1 to continue …” You will know if a medical device is recommended by your doctor through a direct one-on-one conversation with him or her, not through a phone call. This is a scam. Hang up and report the number to SMP.

    Common Phone Scam Tactics:

    • Fraudsters often call consumers early in the a.m.
    • The sales pitch is done rapidly, usually with a foreign accent
    • Callers deliberately confuse people into believing they represent Social Security or Medicare
    • Caller promises a new Medicare card or medical card
    • Caller offers free medical alert equipment (or other free equipment or supplies) to get their checking account information, credit card and/or Medicare number

    Again, if you come across any of these scenarios, see if you can get some information on the caller and their number, hang up and report the scam to our Senior Medicare Patrol at 855-613-7080.

    See our Medicare Fraud section for more info on fraud.

  • 18Feb

    Where can people turn to get unbiased information about the quality of care provided by the thousands of doctors, hospitals, and long-term care providers in California? A new website, CalQualityCare.org, is one good place to go. It was recently created as a one-stop resource to compare hospitals, medical groups, and long term care facilities. CalQualityCare.org is the result of a partnership between the California Healthcare Foundation (CHCF) a non-profit philanthropy, and Consumer Reports and their commitment to ensure all Californians have access to better healthcare.

    Free and easy-to-use, the website features rating information on California hospitals, medical groups, nursing homes, and other long-term care facilities, and reviews a range of measures—such as patient experience, nursing home staffing levels, and hospital quality (including ER wait times). In addition, CalQualityCare.org provides tips and checklists about how to choose a health care provider, questions to ask, how to pay for care, and what to do if something goes wrong.

    Because CalQualityCare.org is not commercial, users can be assured:

    • The site is always be free and offer fully open access
    • The information is objective and unbiased
    • Users are not required to register or provide any contact information
    • Users will not be hounded by aggressive emails and phone calls
    • Users won’t see advertising or promotion of one provider over others

    Visit Calqualitycare.org to see the ratings and find out more. If you’d like to help spread the word on this new resource, you can host a widget on your website.

    The California Healthcare Foundation is a non-profit philanthropy working to fulfill the promise of better health care for all Californians.

  • 13Feb

    Without legal intervention, women could end up paying 40% more for long-term care insurance coverage than men. And this could happen as early as January 2015.  To stop such gender-based pricing products from being sold in California, Assembly member Mariko Yamada has introduced AB 1553.

    Gender discrimination on health insurance premiums is illegal under the Affordable Care Act, but long-term care insurance in California is not classified as health insurance, but rather as disability insurance, so this prohibition does not apply.

    While California is currently 1 of 6 states that does not yet offer such gender-based priced products, this could quickly change if the California Department of Insurance approves the sale of several new long-term care insurance products that are currently under review. Colorado and Montana have already passed legislation to prohibit the sale of such policies.

    “Gender discrimination has broad public policy implications,” Yamada said. “Women earn less than men in their lifetime and accumulate less wealth, so charging women more for the same policies is neither a fair nor effective solution to covering the industry’s costs. Pricing based on life expectancy sets an extremely dangerous precedent.”

    Because women generally live longer than men, they depend on long-term care benefits more and often reduce men’s dependence on these services by serving as their caregivers. According to the American Association of Long-term Care Insurance, almost 70% of women 75 or older are widowed, divorced, or never married. This makes them less likely to have spouses to provide care for them and more likely to reside in assisted living and nursing facilities. Indeed, in California 2 out of 3 nursing home residents are women.

    Many advocates agree that gender-based pricing would make it nearly impossible, especially for women with lower fixed incomes, to afford long-term care insurance. This means many women would have to do without care, and the risk of elderly women falling into isolation and poverty would most likely increase.

    “Women have always had a hard time figuring out how to pay for long-term care insurance from their lower incomes and resources,” said Bonnie Burns, our Training and Policy Specialist. “Gender discrimination will force even more women out of the market, shifting the cost of their care to their families and the state’s Medicaid program.”

    Please join us in supporting AB 1553, contacting your legislator and saying no to gender-based pricing in any form of health insurance.

    This blog is edited from the article, California bill seeks to stop insurers from implementing gender-based pricing.

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