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Karen J. Fletcher is CHA's publications consultant. She provides technical expertise, writing and research on Medicare, health disparities and other health care issues. With a Masters in Public Health from UC Berkeley, she serves in health advocacy as a trainer and consultant.
See her current articles.
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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.
To combat a reported $60 billion lost to waste, fraud and abuse within the Medicare system, a bi-partisan group of U.S. senators and representatives led by Senators Mark Kirk (R-IL) and Ron Widen (D-OR) have introduced legislation to use existing “smart card” technology to protect Medicare beneficiaries. The Smart Card Alliance strongly supports the new Medicare Common Access Card Act of 2011 (S. 1551 and H.R. 2925).
Today’s USA Today newspaper has a prominent article on the Senior Medicare Patrol (SMP) program and the contribution of volunteers nationwide. Since 1997, over 68,000 SMP volunteers have educated 9.2 million people about Medicare fraud, received 87,000 complaints from beneficiaries, and saved Medicare and Medicaid $105.9 million.
The California HealthCare Foundation (CHCF) has put together a series of 6 short, under 5-minute videos on what changes to expect from the Affordable Care Act in the next 2 years.
Some highlights of the changes happening by 2014 include:
Government-funded health insurance (Medi-Cal) will expand to cover 2 to 3 million more Californians who can’t afford their own insurance today.
No one will be able to be denied coverage by an insurance company for having preexisting conditions, or for any other reason.
All Americans will be required to have health coverage, either through their work, through a public program, or by buying it on their own.
Businesses will have to offer adequate coverage to their employees or pay a penalty if those workers end up using government-supported coverage. Small employers with mostly low-wage workers will be eligible for subsidies.
State health insurance exchanges will help consumers shop for policies. Exchanges will help people learn if they are eligible for government-supported health care (like Medi-Cal) or subsidies to help pay for private coverage.
Watch the 6 short videos on the CHCFwebsite. The videos include:
Have you heard about last week’s arrests in a historic takedown by the Health Care Fraud Prevention and Enforcement Action Team (HEAT) Strike Force? This takedown happened in 8 cities and has resulted in charges against 91 defendants, including doctors, nurses, and other medical professionals, for their alleged participation in Medicare fraud schemes involving approximately $295 million in false billing. This is the highest amount of false Medicare billings in a single takedown in the HEAT Strike Force history.
Read the Department of Health and Human Services’ press release for more info.
Here are some highlights from the release:
The schemes involved a variety of services, including: home health care, physical and occupational therapy, mental health services, psychotherapy and durable medical equipment (DME).
The fraudulent practices included submitting claims to Medicare for treatments that were medically unnecessary and oftentimes never provided. In many cases, indictments and complaints allege that patient recruiters, Medicare beneficiaries and other co-conspirators were paid cash kickbacks in return for supplying beneficiary information to providers, so that the providers could submit fraudulent billing to Medicare for services that were medically unnecessary or never provided.
Locations of those arrested include: Baton Rouge, LA; Brooklyn, NY; Chicago, IL; Dallas, TX; Detroit, MI; Houston, TX; Miami, FL; and Los Angeles, CA.
See our Medicare Fraud section for more info on common fraud schemes, and how to detect, report and prevent it.
Those interested in volunteering to put an end to fraud, check out our Senior Medicare Patrol (SMP) program. We are currently accepting new volunteers.
The National Hispanic Senior Medicare Patrol (NHSMP) has launched a new outreach and communications campaign, which includes a Spanish language public service announcement (PSA). The PSA is currently being aired in South Florida through mid-September.
The PSA, titled El Fraude al Medicare es un Delito. Denúncielo. (Medicare Fraud is a Crime. Report It.), is part of the NHSMP’s Spanish language communications toolkit. It was developed based on a needs assessment conducted to gauge the perceptions of the community and understand why they were underreporting Medicare fraud. NHSMP found that although a majority of seniors could identify Medicare fraud, they didn’t know how to report it or felt overwhelmed by their lack of English skills to communicate effectively.
The PSA is posted on Youtube. We encourage you to share it, post it on your webpage and help get the word out on how to stop and prevent Medicare fraud and abuse. For additional Spanish resources, see the available educational outreach and communications tools on the NHSMP webpage. You can also see our Medicare Fraud resources section for additional Spanish materials.
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